Job Stressors and Slow Medicine in Health Care: A Scoping Review.

This paper provides a framework for addressing the stressors in modern medical health care, especially those that relate to psychology and psychiatry. Despite its advances, organized medicine is beset with inefficiencies and imperfections. The extent of burnout and stress for health professionals is documented in this scoping review. The impact on mental health is described and an approach based on a slower medicine is advocated.

The performing arts and psychological well-being.

Although psychotropic drugs have been hailed as, 'One of the success stories of modern psychiatry' the prescribing of these medicines has not been without commotion, concern and controversy. Moreover, the President of the World Psychiatry Association Professor Dinesh Bhugra and colleagues, after conducting a recent large-scale study (n=25,522) on psychiatric morbidity in the UK, collectively issued the clarion call that, 'The mental health of the nation was unlikely to be improved by treatment with psychotropic medication alone'. The provision of mental healthcare services may likely benefit from a holistic approach that includes a variety of treatment options that prioritizes patient safety and preference. The performing arts is gaining popularity among service users as an adjunctive form of treatment for mental illness. There is a growing body of evidence that provisionally supports the claim that art therapy, 'Possesses the power to heal psychological wounds'. The North American Drama Therapy Association defines drama therapy as, 'The intentional use of drama and/or theatre processes to achieve therapeutic goals' and that it is 'active and experiential'. This review article discusses and describes the merits of dramatherapy and how this treatment modality can contribute to a patient's recovery from psychological distress.

[The treatment needs of migrant children according to child and adolescent psychiatrists from medical clinics and in private practice]. / Anforderungen an die Behandlung von Migrantenkindern aus Sicht niedergelassener und leitender Ärzte für Kinder- und Jugendpsychiatrie.

OBJECTIVE: How does the German child and adolescent psychiatry system respond to the increasing number of migrant children and adolescents? METHOD: Senior doctors from German child and adolescent psychiatric hospitals (Association of Medical Hospital Directors in Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany, BAG) completed a specially constructed questionnaire about the treatment needs of migrant children, while a «random, representative¼ sample of child and adolescent psychiatrists in private practice (German Professional Association for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, BKJPP) was administered a slightly modified version. RESULTS: The 100 psychiatrists in private practice represented only about one-eighth of their group, whereas the 55 medical directors comprised a representative sample. One-third of the hospitals has treatments tailored to the specific needs of migrants. In both settings, however, competent interpreters were rarely found, despite the treatment problems arising from the understanding the illness by the parents, language problems, and the clinical knowledge of the patient. Cultural diversity is perceived as enriching. The migration background and the sex of child and adolescent psychiatrists influence the treatment of migrants. CONCLUSION: Facilitating the process of «cultural opening¼ in child and adolescent psychiatry involves enacting concrete steps, such as the funding of interpreter costs.

Perspectives of clinical medical directors in child and adolescent psychiatry: diagnostic and treatment needs of migrant families.

Germany is one of many nations characterized by an increasing number of children originating from families with a migration background. Medical treatment modalities will be required to adjust for diversity of social and cultural background. Initiated by the Federal Society of Child and Adolescent Psychiatry (BKJPP), representing mainly those psychiatrists working in private practice, and by the Federal Working Commission of Medical Directors employed in Child and Adolescent Psychiatric Clinics (BAG), a questionnaire was constructed to identify mental health professionals' (psychiatrists') evaluation of the needs and quality of diagnosis and treatment for migrant families. The current study focused on medical directors and deputy chief physicians in clinics for child and adolescent psychiatry. Preliminary results of this survey - implementing descriptive statistics as well as univariate and multivariate statistical analyses - permitted an assessment of the current state of identification and treatment of migrant offspring attending child and adolescent psychiatric practices in Germany. Recommendations and concrete steps are offered, which aim to promote "cultural opening", and assist in health and social policy makers' decisions for improved mental health care.

Health and educational performance among young migrants.

This study is a part replication of an earlier study by on health efficacy, educational attainment and well-being among 30 nations. It includes, however, data from these nations, as well as the latest Pisa results and update socioeconomic data and sociological variables which include divorce rate, number of persons/household, employment rates, and measures of physical and mental health (including new scales of well-being, e.g., mental health index, life satisfaction, suicide rates). More importantly, it includes measures of migrant rates among children and adults in each country, the focus of attention of this article. New material on health and educational expenditure are provided.

Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.

The objective of this study was to determine the effect of Pilates-based mat exercises on life satisfaction, perception of appreciation by other people, perception of physical appearance, perception of functionality, total physical self-concept, and perception of health status in healthy women. A randomized controlled trial was conducted in Evora, Portugal, in 2008, in which 62 healthy adult women were randomized to a Pilates-based mat (experimental group) (n = 38, mean age ± SD, 41.08 ± 6.64 years) or a control group (n = 24, mean age ± SD, 40.25 ± 7.70 years). Experimental group participants performed the Initial Mat of Body Control Pilates twice per week, 60-minutes per session. Repeated measurements were performed at baseline, 3 months and 6 months. No significant differences between the two groups were observed in life satisfaction, perception of appreciation by other people, perception of physical appearance, perception of functionality, total physical self-concept, and perception of health status at three time point measures (baseline, after 3 months, and after 6 months). No significant differences were observed in the control group over time. The experimental group showed significant improvements between baseline and six months in life satisfaction (p = .04), perception of appreciation by other people (p = .002), perception of physical appearance (p = .001), perception of functionality (p = .01), total physical self-concept (p = .001), perception of health status (p = .013) and between three and six months in life satisfaction (p = .002), perception of appreciation by other people (p = .05), perception of physical appearance (p = .001), perception of functionality (p = .02), and total physical self-concept (p = .001). Life satisfaction, perception of appreciation by other people, perception of physical appearance, perception of functionality, total physical self-concept and perception of health status may improve after 6 months of Pilates-based mat exercise.

Birth order: self-injurious and suicidal behaviour among adolescents.

A sample of 2553 children and adolescents in a psychiatry clinic in Germany were assessed using a structured interview inventory that included history of self-injurious behaviour, suicidal intent and socially disruptive and threatening behaviour, and diverse socio-demographic variables (the basis documentation or 'Ba-Do'). Birth order was associated with both suicidal and self-injurious behaviour, middle children being most likely to exhibit such behaviour. Females were more than twice as likely to have self-injured than males. Comparisons of birth order groups within gender found no significant differences in suicidal behaviour between birth positions for males, however among females, middle children were much more likely to have attempted suicide. Conversely, there was no difference in self-injurious behaviour among birth positions in females, but among males, middle children were significantly more likely to have self-injured than firstborns, only children or lastborns. The number of siblings in the family was significantly correlated with both suicidal history (r = 0.12, p < 0.001) and self-injurious behaviour (r = 0.10, p < 0.001). The risk of suicidal behaviour was highest for those with four or more siblings.

The effects of gender and migrant status on physical and psychological well-being.

Adolescents (n = 962; 55% migrant and 45% native) between the age of 11 and 19 were administered the Kovac's Children Depression Inventory (CDI), Children Trait Anxiety Inventory (CTAI), Offer's Self-Image Questionnaire (OSIQ), and Brähler's Checklist of Symptom Complaints (GBB). Foreign-born and German-born samples were matched for age, gender, and educational status. Females were more anxious and complained more about physical ailments, particularly tiredness, stomach disorders, colds, and circulatory ailments than males, but not for depression. Adolescent migrants did not display any significant differences in terms of physical health, but they did report more depression and anxiety measures. The association between anxiety, depression, and physical ill-health was significant for both males and females, but tended to be more pronounced for females. There was scarce evidence of gender making an impact on the migration-health linkage. The implications of the results are discussed within the framework of migration and health policies for second generation children and their families.

Using short-term concentration measures and intelligence in rehabilitation settings.

Psychological assessment of cognitive functioning among clinical groups that include psychiatric and geriatric patients is a difficult task. This study examines the interrelationship between intelligence and concentrative ability for a group of psychiatric patients. Intellectual and concentrative ability were assessed among a group of 85, predominantly schizophrenic, patients (mean age 32 years) from a Sheltered Workshop (GWN) and neurological-psychiatric institutionalized care units within the Neuss region of North-Rhine Westphalia, Germany. Moderate bivariate relationships were found between all IQ subtests and the concentration performance variables (d2). A substantial overlap in variance was found between "nonverbal" intelligence and the concentration variables (using multiple regression and discrimination analysis). Error rate on the concentration task was significantly negatively correlated with the IQ variables, the magnitude of the correlation coefficient increasing as a function of the time on the task. Future studies would benefit from comparisons in factor structure similarity between abnormal and normal groups as well as between-clinical groups. At a practical level, the relatively easy use (less complex administration) and less obtrusive (hence, low level of personal threat) and inexpensive procedures of the letter cancellation task makes it a useful, albeit "approximate", measure of cognitive functioning.

Disruptive behavioural disorders, self harm and suicidal ideation among German adolescents in psychiatric care.

The present study examines the unique and shared risk factors for suicidal behaviour, self-injury, and externally focussed aggressive behaviour among German youths and adolescents of both sexes. Also explored is the issue of multiple maladaptive behaviours and whether or not these are interrelated. The period of the sample comprised 2002-2003 admissions (N = 3694) to a clinic for child and adolescent psychiatry and psychosomatics. Measures were taken from medical-psychological documentation ("Ba-Do") and self-report questionnaire and included items relating to self-injurious behaviour, suicidal intent and socially disruptive and threatening behaviour (FAPS). Self and expert ratings of suicidal and self-injurious behaviour were significantly statistically correlated. Overt aggression was unrelated to suicidal behaviour. Suicidal and self-injurious behaviour were more common among female than male adolescents. Age, disharmony within the family and excessive parental demands were major global determinants of suicidal behaviour for both genders, but unrelated to self-injurious or socially disruptive behaviour, the latter being more associated with parental under-involvement and feelings of hostile rejection. Intelligence and age were significant predictors of overt aggression among females; intellectual functioning, number of siblings and disability among family members emerged as major determinants of suicidal behaviour among males. Findings are discussed in terms of practice interventions.

Gender, anxiety-depressivity and self-image among adolescents.

Two groups of non- and "quasi-depressives"-the latter corresponding to high depression scorers-German adolescents were examined to determine the effect of gender and depression in predicting physical ailments, self-image and attitudes towards parents. Quasi-depressive adolescents displayed higher frequencies of physical complaints across all five subscales of the Giessen physical complaints inventory compared to the non-depressive counterparts. Females generally reported more ailments (exhaustion, gastrointestinal, circulatory, and colds) than males. In contrast to males who showed scarce difference between depressives and non-depressives, female depressives exhibited substantially higher gastrointestinal ailments than non-depressive females. Depressives emerged as displaying inferior self-images, lower paternal acceptance, and somewhat higher maternal rejection, compared to non-depressives. Female adolescents displayed lower self-image, lower paternal acceptance (but not maternal rejection/acceptance), lower mathematical competency, and higher linguistic competency, when compared to male adolescents.

Getting access to the self: Effects of self-management therapy on the development of self-regulation and inhibitory control in obese adolescents.

BACKGROUND AND AIMS: This study investigated the role of self-regulation competencies in general and specifically in a food-related context for the control of body weight in a three-year weight loss program. METHODS: The sample consisted of 30 male and female adolescents (age range: 11-18 years) who participated in a three-year therapy program for severe obesity (mean BMI at the beginning of the intervention was 33.6). Assessment of self-regulation competencies was conducted at three different stages (1(st)-3(rd) graduation/class year). Therefore, three independent groups of adolescents (N = 10) at these different stages were tested (initial-to final-stage of therapy). At the time of testing the BMI of these groups significantly differed from 38.8 to 28.7. Analyses of covariance were performed to determine whether the adolescents also differed in self-regulation skills like "resistance to temptation" and food-related Stroop interference along with ameliorating their energy-balance regulation. RESULTS: In addition to the main effects of age and body mass index, adolescents further displayed significant improvements of executive functions with respect to resistance to temptation and inhibition. CONCLUSIONS: Interventions aimed at enhancing energy-balance regulation in adolescents may further benefit from efforts to facilitate executive functions such as self-regulation and food-related cognitive inhibition.

Subjective models of psychological disorders: mental health professional's perspectives.

This exploratory study is an extension of previous studies which have applied personal construct theory (PCP) methodology toward a better understanding of the structure and dynamics of multidisciplinary mental (and physical) health care (Kirkcaldy and Pope, 1992; Kirkcaldy et al., 1993, 2000, 2005; Kirkcaldy and Siefen, 1999). In this study we wanted to use similar cluster statistical analyses, not unlike PCP analysis, to identify the diverse subjective models of psychological ailments such as anxiety, depression, psychosis, mania, obsessive compulsive disorder (OCD), post stress traumatic disorder (PTSD), etc., using not the idiosyncratic constructs generated by individual triadic element comparisons, but by selecting those constructs which have been clearly identified in various psychiatric and psychological rating scales (e.g. somatic preoccupation, social withdrawal, conceptual disorganization, hostility, disinhibition and controlling). Clinical experts (psychological psychotherapists, and medical psychotherapist and psychiatrist) each with over 25 years of clinical and research experience were required to complete the ratings of each disorder listed in terms of the pre-formulated behavioral, emotional and cognitive concepts. What emerged are several multivariate (grid) analyses based on mental health professionals' perception of diverse elements (disorders) and their interrelationship derived from the similarity of composite profiles of ill-related constructs. Overall, the analyses revealed clear associations between the subjective evaluations of psychological ailments suggesting some uniformity in mental health assessment of such disorders. The implications of these findings are discussed within the theoretical framework of improved mental health care.

A comparison of general and illness-related locus of control in Russians, ethnic German migrants and Germans.

General and illness-related locus of control play an immensely important role in the adherence and cooperation of patients in their therapy. Until now, culture-specific aspects of these subjective theories have rarely been investigated. However, in view of the growing proportion of migrants in the German population, they are becoming increasingly significant. In a project supported by the Volkswagenstiftung (Volkswagen Foundation), a total of 607 healthy people were surveyed. The sample includes 307 ethnic German migrants from the successor states of the former Soviet Union (descendents of German origin who had emigrated to Russia during the 18th and 19th centuries) and 300 native Russians in Russia. They were compared with 100 Germans (matched from a previous study). The data were collected using questionnaires entitled "Multidimensional Health Locus of Control (MHLC)" and "Illness-related Locus of Control". The ethnic German migrants differed from the Russian sample in their health beliefs and attitudes towards medicine. However, in the first 18 months after migration, hardly any changes were observed. Fatalistic factors played only a minor role. Locus of health control was associated with beliefs about recovery from myocardial infarcts and tumours. Socio-demographic variables were of varying significance in the individual cultures. Gender influences on health beliefs were different in the subsamples. The level of education had only a minor influence on health attitudes. For those individuals who were acquainted with an ill person, internal factors in treatment of myocardial infarct and external psychosocial factors in cure of cancer played a larger role.