[Personnel assessment in psychiatry and psychotherapy : Results of a feasibility study on the platform model]

The topic of personnel assessment in psychiatry, psychotherapy and psychosomatics is currently of great importance in terms of health policy. Sufficient empirical evidence for the development of a comprehensive system for staffing is not yet available. The platform model developed by the psychiatric psychosomatic societies and associations pursues a combined empirical normative approach for a future-oriented assessment instrument for the various professional groups. The concept presented has been proven in the health policy discussion as a sensible system of comprehensive personnel assessment; however, an empirically sound control is still lacking as to whether this system can be used practically for the task described and thus can withstand the task of a resilient and future-proof measurement instrument for the necessary personnel. The task of the present study was to examine the extent to which the assumptions of the platform model are confirmed, whether methodological indications can be identified and whether there are limitations of the study that can be used in the validation and foundation of the model. The study confirmed the feasibility of the model and refers to a number of methodological findings and limitations that can be used for the further development of the model. The developed model allows the necessary staffing to be derived and justified, regardless of diagnoses and settings. It is future-oriented and dynamic.

Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men

BACKGROUND

Although sex and gender are becoming more important in diagnostics and therapy, there is still little knowledge about sex-specific differences in chronic pruritus (CP).

OBJECTIVES

To compare, taking into consideration the characteristics of pruritus, sex-specific differences in psychological symptoms in patients with CP.

METHODS

Sociodemographic data, data on the clinical characteristics of the skin and CP were documented over a 1-year period in all patients attending the Competence Center Chronic Pruritus of the University Hospital Münster for the first time. All patients completed the Hospital Anxiety and Depression Scale. Student's t-tests for independent study groups and linear regression analyses were applied.

RESULTS

A total of 619 patients (278 men, 341 women) were included in the analysis. Women were more anxious than men, but were not more depressed. A linear regression analysis indicated that depression and anxiety scores in women were related to the average intensity of pruritus during the previous 4 weeks and to a more generalized pruritus at the beginning of CP; older age in women also correlated with the scores on the depression subscale. Interestingly, the associations were different in men: scores on the depression scale were associated with the diagnosis of CP pruritus with multiple scratch lesions.

CONCLUSIONS

There are sex-specific differences in the relationship between the psychological symptoms and clinical characteristics of CP; higher anxiety scores were achieved by women. Whether psychological symptoms can be reversed when CP and scratch lesions improve is an issue that needs further exploration.

Is there any association between disturbed gastrointestinal visceromotor and sensory function and impaired quality of life in functional dyspepsia?

BACKGROUND Functional dyspepsia (FD) is now categorized into the epigastric pain syndrome (EPS) and the postprandial distress syndrome (PDS). However, the role of disturbed gastric emptying and sensory function for the reduction of health-related quality of life (HRQOL) has not yet been studied in EPS and PDS. METHODS A total of 300 refractory FD patients and 450 healthy blood donors (BD) were studied. BD were stratified in subjects with (BD+) and without (BD-) concomitant FD symptoms. Gastric motor and sensory function, generic and disease-specific HRQOL [physical (PCS) and mental component summary (MCS)] and affective disorders were assessed. Twenty randomly selected BD-, 50 BD+ (36 PDS, 72%), and 110 FD (95 PDS, 86.4%) patients had additional function testing. KEY RESULTS Health-related quality of life was significantly reduced in FD patients (PCS = 40.7 +/- 8.8, MCS = 39.7 +/- 11.3, both P < 0.0001) compared to BD+ (PCS = 52.0 +/- 7.6, MCS = 49.0 +/- 9.4) and BD- (PCS = 56.0 +/- 4.3, MCS = 52.8 +/- 7.2). GET (t((1/2)), min) was significantly (both P < 0.0001) longer in FD patients (143.0 +/- 7.3) compared to BD+ (101.1 +/- 6.3) and BD- (73.8 +/- 7.6). FD patients scored significantly higher for 'pain' (P < 0.0001) and 'nausea' (P = 0.023), there was no difference for 'fullness' compared to BD. Impairment of GET was not associated with HRQOL. In FD patients, an augmented symptom response to the test meal (fullness, nausea) was associated with MCS, there was no difference between FD patients with EPS or PDS. CONCLUSIONS & INFERENCES In EPS and PDS, delayed gastric empting and altered sensory function are disease markers but not directly linked to the severity of HRQOL impairment or clinical presentation of FD.

Impairment of health-related quality of life in functional dyspepsia and chronic liver disease: the influence of depression and anxiety

BACKGROUND

Health-related quality of life (HRQOL) is a marker of disease severity. Data on the relative impairment of HRQOL in chronic liver disease (CLD) and functional gastrointestinal disorders are lacking and no studies have assessed the link between impairment of HRQOL and psychosocial factors yet.

AIM

To assess predictors for, and the impairment of, HRQOL in CLD and FD.

METHODS

In 181 functional dyspepsia (FD) patients, 204 CLD patients and 337 healthy blood donors, HRQOL was assessed with the Short Form-36 (mental and physical component), and anxiety and depression utilizing the Hospital Anxiety and Depression Scale.

RESULTS

Compared with HC, HRQOL is significantly lower in FD and CLD (P-value for all <0.001). The mental but not physical component of HRQOL was significantly more impaired in FD compared with CLD (P < 0.05). After adjusting for confounders, impairment of mental (P < 0.001) and physical (P = 0.005) component of HRQOL was associated with the severity of CLD and FD. In FD, the multivariate analysis revealed depression and severity of symptoms as the most important predictors of HRQOL (R2 = 21.9 and 7.1). In CLD, the mental component of HRQOL was associated with depression and anxiety (R(2) = 9.9 and 9.7).

CONCLUSIONS

In tertiary care, HRQOL is more severely impaired in FD compared with CLD. Co-morbid psychiatric conditions significantly contribute to the impairment of HRQOL.

[The IREPRO List of Indicators--a tool for systematic evaluation of the prognosis for reintegration and the need for rehabilitation in the course of psychiatric disability pension assessment]

There is little research on the process of decision making in sociomedical expert opinion especially on prognostic issues. Experts therefore have to rely upon experience and their own routines of judgement. The IREPRO List of Indicators offers a systematic scheme for the sociomedical exploration and evaluation of the prognosis for reintegration and the need for rehabilitation in claimants for disability pension due to mental illness. A set of ten indicators was defined and its practical use tested in an expert-based process of development. In a manual each indicator is thoroughly described in a standardized manner including a five-point rating scale. In a profile sheet the ratings of all ten indicators are visualized, appropriate therapeutical and rehabilitative means are assigned, and the final judgement of prognosis is deduced. At present the IREPRO List of Indicators offers a good tool to structure the process of decision making and contributes to enhancing transparency and uniformity of the process. It can also be used to discuss cases among colleagues. The basic principle can be transferred to other fields of sociomedical expert opinion-building. The article describes requirements and difficulties in psychiatric disability assessment, the list of indicators and experiences gained from the process of development.

[Anxiety and depression after loss of a lower limb]

A good number of psychosocial-, disease-, and disability-related variables influence the adaptation process after the loss of a lower limb. In this case psychological problems, as a result of a failed adaptation process, are common. Of the 75 patients examined who had an amputation of a lower extremity 27% showed increased depression and 25% increased anxiety scores; 18.3% showed higher than normal scores in both categories. Regression analysis showed that in addition to pain reception poor acceptance of the prosthesis is an important predictive factor for the development of psychological disorders and diseases like anxiety and depression. Therefore, measures for psychological diagnostics and care should be initiated soon after the amputation to prevent psychological abnormalities. Here interdisciplinary management and cooperation of the professions involved in the care of the patient are recommended.

Is there a benefit from intensified medical and psychological interventions in patients with functional dyspepsia not responding to conventional therapy?

AIM

In a prospective randomized, controlled trial, to compare the long-term outcome of intensive medical therapy (with or without cognitive-behavioural or muscle relaxation therapy) vs. standard medical therapy in patients with refractory functional dyspepsia (FD), referred to a tertiary referral medical center.

METHODS

A total of 100 consecutive FD patients were allocated to a standardized symptom-oriented 4 month therapy (SMT, n = 24), intensive medical therapy (IMT, medical therapy with testing-for and targeting-of abnormalities of motor-and-sensory function, n = 28) or IMT plus psychological interventions (either progressive-muscle relaxation (IMT-MR, n = 20) or cognitive-behavioural therapy (IMT-CBT, n = 28). The symptom intensity (SI) and health-related quality-of-life (HRQoL) after 12 months were prespecified primary outcome parameters.

RESULTS

After 12 months, significantly greater improvement of SI occurred in patients with IMT-all (with or without psychological interventions) compared with SMT (P < 0.025 vs. IMT-all). IMT, IMT-MR and IMT-CBT alone also resulted in significantly better improvement of the primary outcome parameters (P all < 0.025 vs. SMT). HRQoL significantly improved in all groups with intensive medical therapy but not standard medical therapy. Differences between intensive medical therapy-all and standard medical therapy were not significant. Concomitant anxiety and depression was improved significantly by IMT-CBT (vs. SMT) but not other treatments.

CONCLUSIONS

In FD patients with refractory symptoms, intensified medical management involving function testing and psychological intervention yields superior long-term-outcomes. Additional CBT may be effective for the control of concomitant anxiety and depression.

Psychosomatic cofactors and psychiatric comorbidity in patients with chronic itch

BACKGROUND

While psychosomatic factors may be involved in eliciting as well as coping with chronic itch, psychiatric comorbidity often goes unrecognized in dermatological patients.

AIM

To record psychiatric illness, psychiatric and psychotherapeutic pretreatment, and psychotherapy indication in dermatology inpatients with pruritus.

METHODS

A consecutive sample of 109 dermatology inpatients with the symptom of pruritus were examined by interviews with consecutive ratings by experts (using psychiatric ICD-10 diagnoses, the Global Assessment of Functioning Scale and the Impairment Score) and self-assessment using the the Eppendorf Itch Questionnaire.

RESULTS

In > 70% of the pruritus patients, 1-6 psychiatric diagnoses could be demonstrated. In > 60%, psychotherapeutic or psychiatric treatment was recommended. In contrast, almost 90% of the patients had had no previous psychotherapeutic experience.

CONCLUSION

As psychiatric comorbidity in dermatology inpatients suffering from chronic itch is high, dermatology departments should aim for an improvement of their psychosomatic consultation and liaison services.

Psychological factors in prurigo nodularis in comparison with psoriasis vulgaris: results of a case-control study

BACKGROUND

It has been suggested that psychological factors such as repressing anger and altruistic interpersonal behaviour may play a role in the aetiology of chronic itching in prurigo nodularis (PN). Whether these issues are specific for PN or are also common in other chronic skin diseases, e.g. psoriasis, has not been investigated until now.

OBJECTIVES

To investigate psychosomatic problem areas and psychiatric comorbidity in patients with PN in comparison with patients with psoriasis.

METHODS

Ninety-four patients with PN and 91 patients with psoriasis were administered the Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale, State-Trait Anger Expression Inventory, Inventory of Interpersonal Problems, Screening for Somatoform Disorders and the Whiteley Index for hypochondriasis.

RESULTS

After Bonferroni post hoc adjustment, the metrical scales demonstrated no significant differences between patients with PN and those with psoriasis. There was only a tendency to less 'anger-out' and to less autocratic/dominant and more insecure/submissive behaviour in the patients with PN. Patients with PN were, in general, comparable with those with psoriasis with regard to alexithymia, somatization symptoms, hypochondriasis, anxiety and depression, with 18% cases of anxiety and 22% cases of depression.

CONCLUSIONS

The hypotheses formulated in the literature on the specific aetiology of PN could not be proven for the majority of patients with PN in our study. Concerning their psychopathology, patients with PN were comparable with those with psoriasis. Therefore the clinical management of PN should include psychosomatic assessment.

[Comorbidity of mental and internal medical disorders in inpatients treated at the clinic for technical orthopedics]

Due to the severity of their clinical picture and their shattered sense of physical inviolability that almost always is associated with their condition as well as their changed physical appearance, inpatients being treated at the clinic for technical orthopedics frequently exhibit comorbid mental disorders. This article examines these mental health comorbidities. The proportion of adjustment disorders in this group was shown to be noticeably higher than in a comparative group of outpatients attending a psychosomatic/psychotherapeutic clinic. Furthermore, diabetes mellitus proved to be another statistically significant organic comorbidity in the patients treated at the clinic for technical orthopedics. This article discusses the extent to which the chronicity of this disease affects the psychosomatic diagnoses but also the course of the treatment in the clinic for technical orthopedics. In conclusion, this article emphasizes the need for close interdisciplinary management for this highly selected patient group because of the high rates of comorbidity.

Ver�nderung einer Stichprobe =60-j�hriger Krankenhauspatienten nach 5 Jahren: Ergebnisse der ELDERMEN-Study

METHOD

The ELDERMEN Study, which was funded by the German Research Association, comprises baseline assessment during 1994-1997 and a second assessment during 2000-2002. A total of 261 in-patients participated in an extensive examination at baseline assessment and were contacted again five years later.

RESULTS

Five years after baseline assessment, 135 former participants had deceased, 29 newly fulfilled exclusion criteria. Of the 97 individuals who matched the study's inclusion criteria at the second assessment, 74 participated in the second evaluation. Baseline assessment revealed no significant differences between participants at second assessment and those persons who refused the second participation. However, participants in the extensive examination and longitudinal design were a positive selection when compared to the whole baseline sample.

DISCUSSION

Because of increasing morbidity and mortality, longitudinal gerontological studies have to deal with the problem of selective diminishment of the sample, which can endanger the validity and generalizability of results. The problem has to be dealt with by careful documentation and evaluation of selectivity effects. We focus on the problems of longitudinal studies in gerontologic research and examine the longitudinal development of a sample of geriatric in-patients aged > or = 60 years.