[Teaching about chronic pain in psychosomatics courses - an overview of the situation in Germany and the Tübingen Model]. / Schmerzmedizin in der psychosomatischen Lehre ­ Deutschland-Übersicht und Tübinger Modell.

Teaching about chronic pain in psychosomatics courses - an overview of the situation in Germany and the Tübingen Model Objectives: When dealing with chronic pain patients it is crucial to take a bio-psycho-social approach. However, it is unclear how this approach is currently being taught to medical students, and how they judge its role and importance. METHODS: We carried out a qualitative study (questionnaire) asking (1) German psychosomatic departments about pain-related teaching and (2) medical undergraduates about pain-relevant issues. RESULTS: Bio-psycho-social facts are well represented within psychosomatics courses but only theoretically tested. There is still much room for improvement through cross-linking with other disciplines. In Tübingen, "psychosocial factors" and the "empathic doctor-patient relationship" play a significantly higher role when teaching psychosomatic courses than somatic ones. There were no significant differences regarding the role of an "integrative recording of medical history" or how the importance of any of the three topics was rated. CONCLUSIONS: Chronic pain is well represented in psychosomatic courses in Germany, though exams could be more practical. The establishment of interdisciplinary approaches beyond the teaching of core psychosomatic content could be expanded and especially used more frequently when adapting curricula to competence-based standards.

Communication skills of medical students during the OSCE: Gender-specific differences in a longitudinal trend study.

BACKGROUND: Communication skills are essential in a patient-centred health service and therefore in medical teaching. Although significant differences in communication behaviour of male and female students are known, gender differences in the performance of students are still under-reported. The aim of this study was to analyse gender differences in communication skills of medical students in the context of an OSCE exam (OSCE = Objective Structured Clinical Examination). METHODS: In a longitudinal trend study based on seven semester-cohorts, it was analysed if there are gender differences in medical students' communication skills. The students (self-perception) and standardized patients (SP) (external perception) were asked to rate the communication skills using uniform questionnaires. Statistical analysis was performed by using frequency analyses and t-tests in SPSS 21. RESULTS: Across all ratings in the self- and the external perception, there was a significant gender difference in favour of female students performing better in the dimensions of empathy, structure, verbal expression and non-verbal expression. The results of male students deteriorated across all dimensions in the external perception between 2011 and 2014. DISCUSSION & CONCLUSION: It is important to consider if gender-specific teaching should be developed, considering the reported differences between female and male students.

The place of additional individual psychotherapy in the treatment of alcoholism: a randomized controlled study in nonresponders to anticraving medication-results of the PREDICT study.

BACKGROUND: Goal of the presented study is to evaluate whether alcohol-dependent patients given additional individual psychotherapy after a heavy relapse during pharmacotherapy remain abstinent for longer than those who continue with pharmacotherapy alone. METHODS: In a randomized, multicenter study, 109 alcohol-dependent patients who had suffered a heavy relapse either while receiving anticraving medication or placebo were randomized into 2 groups. One group received medication, medical management, and additional individual, disorder-specific, cognitive-behavioral psychotherapy, while the control group received medication and medical management only. Main outcome was defined as days until first heavy relapse. RESULTS: Fifty-four patients were randomized to the psychotherapy group, 55 to the control group. Intention-to-treat and completer analyses found no differences between groups, whereas as-treated analyses (patients who actually received psychotherapy compared with those who did not) found a significant effect of psychotherapy. CONCLUSIONS: Our data indicate that patients that are willing to attend psychotherapy benefit from receiving psychotherapy in addition to pharmacotherapy. We suggest that it may be beneficial to consider patients' preferences concerning psychotherapy at an earlier stage during treatment.

[Extensive interactions between eating and weight disorder, major depression, pain, and sarcoidosis - case 5/2012]. / Komplexe Wechselwirkung von Ess- und Gewichtsstörung, Depression, Schmerzstörung und Sarkoidose - Fall 5/2012.

HISTORY AND ADMISSION FINDINGS: We report on a 41-year-old female patient suffering from obesity, binge eating more than twice a week with loss of control, eating rapidly and feeling guilty after eating, dyspnoea and chronic pain in the whole body, especially in her arms, legs and in both ankles. Furthermore, subdued mood, loss of interest and pleasure, fatigue and impaired concentration could be recognized. In the past, weight increase had been observed when corticosteroids were given against exacerbations of sarcoidosis. INVESTIGATIONS: In the case of our patient, the beginning of sarcoidosis and increase of weight and pain correlated with augmentation of depression and psychosocial stress. Dysfunctional behavioral features and multiple interactions between diseases could be observed. DIAGNOSIS, TREATMENT AND COURSE: We diagnosed obesity, binge eating disorder, major depression, chronic pain disease with somatic and psychical components and sarcoidosis. The patient was treated in a multimodal therapy program including psychotherapy, pharmacotherapy and psychopharmacotherapy, nutritionist advice and therapeutic exercise. A weight loss of 7.9 kg (5.9 %), well-balanced diet, reduction of binge eating and of pain intensity, mood stabilization as well as perception and expression of emotions and coping strategies in chronic diseases were achieved. CONCLUSION: Interdisciplinary treatment of patients suffering from psychosomatic, somatic and mental diseases is crucial for a good outcome.