Burnout and personality in intensive care: an empirical study.

Previous research into the causes of burnout has mainly been concerned with external triggers, such as onerous work criteria or organizational or social influences. Factors such as individual reactions and personality have largely been ignored as a possible etiology of burnout. In preparation for a long-term study, this general cross-sectional study investigates the relationship between burnout and personality variables. Different personality variables that have a possible impact on burnout were determined in a number of prestudies. The data were gathered from 119 people working in intensive care units. The Maslach Burnout Inventory (MBI) was used as well as certain subscales of the following personality questionnaires: Eysenck Personality Inventory (EPI), Inventory of Aggressivity (IA), Trier Personality Questionnaire (TPQ), Scales of Control (SC), Locus of Control (LC), and the Logo-test (LOGO). The scales of mental health, respectively Psychoprotection, external locus of control, and neuroticism, were confirmed as being statistically relevant concerning burnout. The application and significance of this study for future burnout research are discussed.

[Concepts of vulnerability of psychiatric diseases]. / Vulnerabilitätskonzepte bei psychischen Störungen.

Despite intensive research in recent decades, the search for the aetiopathogenesis of psychiatric diseases is just as relevant as ever. In recent years, ideas of the aetiopathogenesis of psychotic diseases based on the concept of "vulnerability" in its diverse variations and developments have been gained increasingly ground. The publications of Zubin and associates above all have contributed to a "vulnerability model". According to this descriptive model, schizophrenic disturbances develop as a result of stimuli/irritants or stress factors under modulation of the social and physical environment as well as dependent on the premorbid personality. The increased vulnerability which gives rise to this is perceived as a threshold descensus of the individual towards stimuli/irritants (with a deficit counter--irritants impulses). Apart from that, multi-causality of vulnerability is assumed as the starting point, whereby there is the possibility of several therapy approaches. Moreover, contrary to the prevailing pessimistic view that schizophrenia is a process-type progressive disease, an episodic nature of schizophrenic psychoses is postulated with a prognosis that is indeed positive in the long term. In recent years, although often not explicitly stated, Zubin's concept of vulnerability was also indubitably subjected to various further developments (the vulnerability stress model by Nuechterlein and associates as also the integrative psycho-biological schizophrenia model by Ciompi may serve as examples). Worth mentioning are also various new concepts from system sciences (such as those from cybernetics, synergetics, the chaos theory, the communication theory, structure determinism etc.), which endeavour to clarify the problem of psychosis. The evaluation of central neurophysiological function deviations with schizophrenics and their relations has so far been oriented above all towards the vulnerability model of Zubin and Nuechterlein, which differentiates temporarily relatively stable trait markers with generally unaltered expressivity at the pre-, intra-, and post-psychotic stages as well as episode markers and intermediate markers. However, specific factors contributing to the pathogenesis of schizophrenic disturbances have not as yet been found, in addition, there is still a multitude of methodological problems and distinctive features to fulfill the expectation of a comprehensive concept with which the whole complexity of the occurrence, the progress, and the outcome of psychoses can be explained. Reintroduction of the concept of vulnerability experienced, as Schmidt-Degenhardt put it, "a renaissance in use that appeared almost inflationary and a completely dubious popularisation ... without reference to its historical implications...". Consequently, a critical view of the use of this term would appear to be necessary.

General introduction to the psychotherapy of Pierre Janet.

This article deals with Pierre Janet's concept of "Psychological Analysis" (analyse psychologique). It brings out Janet's criticism of Sigmund Freud's ideas, and delineates the difference between psychological analysis (Janet) and psychoanalysis (Freud). Further it points out that Janet's theories on the pathogenesis of neurotic disorders rely on the concept of psychic trauma and associated fixed ideas. Mental force and mental tension, described in greater detail, are essential for the pathogenesis of mental disorders. According to Janet, a significant characteristic of the neurotically disturbed person is a feature that Von Gebsattel calls "Werdenshemmung" ("inhibition of becoming"), a state which impairs the life development of the ill person.

[Psychosocial competence of general practitioners in managing psychiatric patients: initial results of a questionnaire study]. / Psychosoziale Kompetenz von Hausärzten und Versorgung psychisch Kranker: erste Ergebnisse einer Fragebogenstudie.

OBJECTIVE: Given the frequency of patients with psychosocial problems and mental disorders in primary care our study focuses on the relationship between the psychosocial qualifications of general practitioners and their management of these patients. METHOD: A questionnaire was sent to all general practitioners in Hessen asking for sociodemographic and profession-related data as well as their psychosocial competence and their procedure during a regular day in practice. Based on 396 questionnaires we compared five groups of general practitioners with different psychosocial qualifications, proportionate incidence of diagnoses, medical procedures and referrals to specialists and hospitals. RESULTS: The average age of the participants of our study is 45 years, they have been working for 14 years. 163 general practitioners without and 59 with a special interest in psychosocial qualification and 174 psychosocially qualified physicians participated in the study. Of a total of 65 patients seen during the reference day 18 were diagnosed as suffering from mental disorders. Their number increased with greater psychosocial competence of the physicians. Psychosomatic and reactive disorders are the most frequent mental disorders to be seen in primary care with nearly 60%. Verbal therapy is often applied, procedures of the so-called psychosomatic basic care and prescription of psychotropic drugs play only a minor role. Nearly every fourth patient is referred to other specialists, referrals for inpatient treatment occur with 1.3% only. DISCUSSION: Because of the low response rate our study is not representative. Nevertheless the results permit some conclusions concerning the relationship between psychosocial qualification of general practitioners and their management of patients with mental disorders.

[Coping behaviors in Parkinson's disease]. / Krankheitsverarbeitung bei Morbus Parkinson.

In 45 patients with Parkinson's disease, we investigated coping behavior and its correlations to demographic and disease-related data, locus of control, depression, and psychosocial adaptation. Active, problem oriented, and self-reorganizing strategies were predominantly used and regarded as especially helpful by the 27 men and 18 women (age: 56 years; duration of illness: 9 years). While age and sex were not associated with coping, external locus of control correlated positively to "depressive coping" and duration of illness correlated negatively to "distraction and self-affirmation." Coping strategies regarded as maladaptive and a small degree of internal locus of control correlated to unfavourable results for depression and satisfaction.

Coping with Parkinson's disease and refractory epilepsy. A comparative study.

Coping strategies and their correlations with demographic and illness related data, depression, locus of control, and psychosocial adaptation were investigated in 45 patients with Parkinson's disease and 40 patients with intractable epilepsy. Three standardized self-report questionnaires were applied: the Freiburg Questionnaire of Coping with Illness (FKV), the von Zerssen Depression Scale (D-S), and the IPC-questionnaire measuring generalized locus of control beliefs. The Social Interview Schedule (SIS), a semi-structured interview, was used to measure psychosocial adaptation. Active, problem-focused and compliance strategies were predominantly used and regarded as most helpful in both groups of patients. Hence, Parkinson and epilepsy patients used similar coping patterns despite the strong dissimilarities of symptoms and illness-associated burdens. The level of depression was not significantly different in both groups and in the range of other chronic somatic diseases. The use of coping patterns, which are regarded as maladaptive, was correlated with distinct depression and a poor psychosocial adaption. In conclusion, no indications for illness-specific coping patterns were found in patients with Parkinson's disease and epilepsy. In both groups, certain coping strategies are associated with good and others with poor psychosocial adjustment. These results indicate the possibility of improving psychosocial adjustment by supporting effective strategies.

Reliability of biographical data, their relations to personality variables and their influence on life-events.

BACKGROUND: First, this study aims to investigate the reliability of biographical and personality data, i.e. analysing the impact of depressive mood on these variables. Second, the influence of early life experience and personality on the reporting of life events was examined. METHODS: Self-reporting questionnaires were administered for a sample of 250 depressive subjects at the beginning, and to assess the influence of depressive mood on the reporting of biographic data at the end of inpatient treatment we used a random sample of 50 subjects out of the 250 patients. RESULTS: Biographical data, unlike personality data, are not significantly influenced by depressive mood and depressive cognition. The number of life-events, and their mean subjective stress, neuroticisms and aim-relatedness are on a direct path strongly influenced by biographical data. That means that the more negatively primary socialisation was reported, the more life-events were communicated, with corresponding increases in the reporting of their subjective stress, and more neuroticism and less aim-relatedness, and vice versa. Neuroticism strongly influences in a positive way, and aim-relatedness negatively influences in a medium way, the number of life-events and their subjective stress. That means the higher neuroticism and the lower aim-relatedness were reported, the more life-events and higher stress were communicated, and vice versa. CONCLUSION: Linear causal processes from mood-independent factors (e.g. biographical factors, vulnerability) may be the beginning of cyclic causal processes, i.e. vicious circles between life-events and mood-dependent factors (e.g. personality variables). LIMITATIONS: According to the design of the investigation there is no differentiation possible between personality and depression. CLINICAL RELEVANCE: To avoid vicious circles between life-events and mood-dependent factors, preventive psychotherapeutic intervention seems to be necessary to avoid the genesis of harmful life-events.

[Evaluation and utilization of complementary medical procedures--a survey of 793 physicians in general practice and the clinic]. / Beurteilung und Verbreitung komplementärmedizinischer Verfahren--eine Befragung von 793 Arzten in Praxis und Klinik.

It is well known that complementary medicine is demanded by numerous patients and used by many doctors. In a representative postal survey of 793 female and male doctors working in practices and hospitals in the town and in the district of Kassel we could confirm the wide distribution of these procedures, especially as far as doctors in practice are concerned. It was the special interest of our study to analyse the motives for the use and the indications and to ask for a detailed and differential assessment of 18 complementary techniques.

The evaluation of life event data.

Data from three life event studies are compared. The interviews covered events that occurred within a period of 2 years before interview. The same inventory was used in each of the studies. Samples were drawn from depressives, myocardial infarction patients and an industrial worker population. The patient groups were interviewed twice within 4 weeks. Fewer than 50% of the total number of events reported in the retests were recorded twice. For events reported in both interviews the correlations of subjective appraisals were only moderate. There is considerable fall-off for reports of events occurring more than 6 months before interview. It was expected that the severest events would have the lowest, and the least severe ones the highest frequencies. Instead, inappropriate labels of the rating scales led to clusterings of severity ratings at their extreme points. Numbers of events and severity ratings were positively correlated with measures of depression.

[Similarities and differences of existential analysis and psychoanalysis]. / Gemeinsamkeiten und Unterschiede von Daseinsanalyse und Psychoanalyse.

The concise curriculum vitae of the founder of existential analysis is followed by an introduction to the five stages of the development of that psychotherapy: the stage of learning, of practice, of criticism, of the alternative to psychoanalysis and of reconciliation. The criticism aimed especially at Freud's naturalism and at the concept of drive. These concepts were opposed by ontoanalytic doctrines derived from the Heidegger's ontoanalysis. The differences between both psychotherapies were exemplified by a presentation of the treatment of a "hysterical phobia" which was originally explained in psychoanalytic and later in ontoanalytic terminology.

[The significance of the Balint-group work: a review of the literature and an empirical study in Unterfranken]. / Die Bedeutung der Balintgruppenarbeit: Ein Literaturüberblick und eine empirische Studie in Unterfranken.

The group work initiated by Michael Balint aims at a comprehensive understanding of the doctor-patient-relationship and a patient-centered medicine. In a review of the literature some studies are presented, which focus on results of Balint work and changes in the participants of this group method. An empirical study of 436 physicians in Unterfranken shows that about 9% have participated in Balint work. Attitudes and motivations of the participants and setting and results of Balint work are studied as well as notions and knowledge of those, who have not done Balint work yet. The study demonstrates positive results in most of the participants.

[The facial profile and personality picture in children]. / Gesichtsprofil und Persönlichkeitsbild bei Kindern.

Facial skeletal malformations may not only lead to impaired function, but also diminish psychosocial well-being. Negative social experiences often arise from stereotyped character judgments such as those connected with the profile of the jaw. In this study, 146 orthodontic patients aged between nine and 14 years and student control subjects judged silhouettes of typical Angle class I, II/1 and III profiles on the basis of semantic differential and sociometric choice techniques. Moreover, the satisfaction of the subjects with the appearance of their heads and bodies, as well as their self-perceived personalities, were assessed with the aid of psychological inventories. Class II/1 profiles were characterised as rather shy, reserved, and melancholic, while to class III profiles were attributed reduced social acceptance and less popularity at school. In general, judgement of the silhouette profiles proved to be independent of the judge's own profile. Thus, the existence of trait stereotypes vis-á-vis class II/1 and class III profiles can be confirmed experimentally in children, too. The impact of social stereotypes on psychological well-being, however, is likely to be modified by numerous factors, in particular by social interaction.

[Ethical aspects of psychotherapy]. / Ethische Aspekte der Psychotherapie.

There are many ethical problems in theory and practice of psychotherapy. Aims of therapy, effectiveness, side effects and modalities of therapy are discussed in detail. The dependency of these aspects from anthropological considerations and understanding of illness is stressed. As far as side effects of psychotherapy are concerned abuse of the patient by the psychotherapist is distinguished from those potentially harmful effects which are due to the specific process of psychotherapy. The relationship of psychotherapy to psychopharmacotherapy is discussed in a special passage.

[Achievement motivation in essential hypertension: an empirical study]. / Leistungsmotivation bei essentiellen Hypertonikern: Eine empirische Studie.

The influence of achievement-motivation on hypertonia was investigated by a psychometric questionnaire for achievement-motivation with four scales: achievement-motivation, steadiness and diligence, positive examination-anxiety and negative examination-anxiety. The sample of 53 persons was drawn by chance out of an unbiased set of hypertonic patients. Mean by age: 45 years; part of female: 28 subjects; part of male: 25 subjects; vocational school: 16 subjects; high-school: 20 subjects; academics: 20 subjects. The sample of the hypertonic patients was compared with a matched sample of normotonics, concerning sex, age, and education and also with the sample for the construction of the questionnaire. There were significant differences (p = .05) of the hypertonics in the scales achievement-motivation, steadiness and diligence, and positive examination-anxiety but no difference in negative examination-anxiety. The results were discussed with regard to neurophysiological activation theory.

[Psychometric differentiation of schizophrenic and schizoaffective psychoses]. / Psychometrische Differenzierung schizophrener und schizoaffektiver Psychosen.

The investigation aims at cognitive deficits of schizoaffective disorders, at the differentiation of the schizomanic and the schizodepressive subtypes, and at the cognitive differentiation of schizophrenic and schizoaffective disorders. Schizoaffective patients show no cognitive deficits in comparison to a nonclinical sample. There are no cognitive differences between the schizomanic and the schizodepressive subtype, but significant differences between schizophrenic and schizoaffective patients in test-scores concerning concentration and abstract reasoning. No differences in test-scores concerning verbal abilities are found.

[Mood and emotions in autogenic training]. / Stimmung und Befindlichkeit beim Autogenen Training.

The effects of Autogenic Training on mood and feeling (assessed by an adjective list) were investigated with personality (assessed by the Eysenck Personality Inventory) and suggestibility (assessed by a questionnaire) and the state of training (assessed by regular training) as independent parameters. There are positive and immediate effects of the training on mood and feeling as well, especially for the scales: activity, extra-/introversion, irritation, anxiety and depression.

[Disorders of language and cognition in schizophrenic patients and their effect on communication]. / Sprach- und Kognitionsstörungen bei Schizophrenen und der Einfluss auf die Kommunikation.

The subjects of this study are disturbances of concept formation in schizophrenics and the influence of that disorder on communication. The verbal coding and recognition of colours of a group of chronic schizophrenics and their normal controls were investigated. In describing the colours, the schizophrenics showed less variability, lower utterance lengths, and shorter reaction times for coding. These symptoms were interpreted as an indication that the schizophrenics don't realize the complexity of the task and differentiate less between the different descriptions (over inclusion). This higher stereotypy contradicts the suggested higher creativity of schizophrenics. No difference was found between the coding of schizophrenics and that of normals in communication with normals. However the schizophrenics showed a deficit of decoding. This was also interpreted as an indication of enlarged concepts within the meaning of the conception of "over inclusion".

[Efficiency factors in psychotherapy--specific and nonspecific influences]. / Wirkfaktoren der Psychotherapie--spezifische und unspezifische Einflüsse.

The effectiveness of psychotherapy is discussed especially concerning the problem of specific versus unspecific factors and their possible interdependence. After a critical review of the results of the evaluation research some important paradigmatic papers on the differential operation of psychotherapeutic methods were evaluated. As there are no doubts that psychotherapy is effective in general even if it was performed by untrained therapist the impact of the specific and the unspecific factors has been investigated. As a result there was no convincing proof for the efficiency of specific factors in psychotherapy. As a consequence the unspecific factors have to be considered as highly effective in psychotherapy. Some models of the relationship factors were demonstrated and discussed.

[Perception, expression and psychosomatic functions]. / Erlebnis, Ausdruck und psychosomatische Funktionen.

The investigation starts with the mind/body-problem and with epistemological peculiarities of psychophysical processes. Every monism has to be conceived at least as a dualism of properties. As a special kind of dualism the functionalism is an example against the type/type-identity thesis but not against the token-/token-identity thesis. But the last one is no serious alternative for genuine psychological methods. But also the functionalism does not offer a complete psychological theory: there is an ambivalence concerning the secondary qualities and also concerning intentionality. Bodily expressions were analyzed according the semiotic theory of Charles Sanders Peirce.

[Cognitive performance profile in schizophrenic patients]. / Kognitives Leistungsprofil bei Schizophrenen.

The cognitive abilities of 189 schizophrenics were investigated by standard tests of intelligence, verbal and non-verbal, selected according to current models of information processing in schizophrenia, to show a specific cognitive deficit. The diagnostic procedure followed the St. Louis research diagnostic criteria. The following cognitive profile has been found: Good verbal abilities and good abilities in verbal abstractions, middle-sized deficit in non-verbal intelligence and non-verbal abstractions but also in cognitive accuracy and in the range of attention. The deficit in concentrations was very high. This characteristic cognitive profile is very useful for the rehabilitation of the patients and probably also for the diagnosis.