The multicenter effectiveness study of inpatient and day hospital treatment in departments of psychosomatic medicine and psychotherapy in Germany.

Background: Reliable outcome data of psychosomatic inpatient and day hospital treatment with a focus on psychotherapy are important to strengthen ecological validity by assessing the reality of mental health care in the field. This study aims to evaluate the effectiveness of inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy in a prospective, naturalistic, multicenter design including structured assessments. Methods: Structured interviews were used to diagnose mental disorders according to ICD-10 and DSM-IV at baseline. Depression, anxiety, somatization, eating disorder and posttraumatic stress disorder (PTSD) symptoms, as well as personality functioning were assessed by means of questionnaires on admission and at discharge. Results: 2,094 patients recruited by 19 participating university hospitals consented to participation in the study. Effect sizes for each of the outcome criteria were calculated for 4-5 sub-groups per outcome domain with differing severity at baseline. Pre-post effect sizes for patients with moderate and high symptom severity at baseline ranged from d = 0.78 to d = 3.61 with symptoms of PTSD, depression, and anxiety showing the largest and somatization as well as personality functioning showing somewhat smaller effects. Conclusions: Inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy is effective under field conditions. Clinical trial registration: https://drks.de/search/de/trial/DRKS00016412, identifier: DRKS00016412.

What Kind of Patients Receive Inpatient and Day-Hospital Treatment in Departments of Psychosomatic Medicine and Psychotherapy in Germany?

INTRODUCTION: Germany is one of the few countries with a medical specialty of psychosomatic medicine and psychotherapy and many treatment resources of this kind. OBJECTIVE: This observational study describes the psychosomatic treatment programs as well as a large sample of day-hospital and inpatients in great detail using structured diagnostic interviews. METHODS: Mental disorders were diagnosed according to ICD-10 and DSM-IV by means of Mini-DIPS and SCID-II. In addition to the case records, a modified version of the CSSRI was employed to collect demographic data and service use. The PHQ-D was used to assess depression, anxiety, and somatization. RESULTS: 2,094 patients from 19 departments participated in the study after giving informed consent. The sample consisted of a high proportion of "complex patients" with high comorbidity of mental and somatic diseases, severe psychopathology, and considerable social and occupational dysfunction including more than 50 days of sick leave per year in half of the sample. The most frequent diagnoses were depression, somatoform and anxiety disorders, eating disorders, personality disorders, and somato-psychic conditions. CONCLUSIONS: Inpatient and day-hospital treatment in German university departments of psychosomatic medicine and psychotherapy is an intensive multimodal treatment for complex patients with high comorbidity and social as well as occupational dysfunction.

Improvement of pain experience and changes in heart rate variability through music-imaginative pain treatment.

Music-imaginative Pain Treatment (MIPT) is a form of music therapy addressing pain experience and affective attitudes toward pain. It includes two self-composed music pieces: one dedicated to the pain experience (pain music, PM) and the other to healing imagination (healing music, HM). Our non-experimental study addresses patients with chronic somatoform pain disorders participating in MIPT. The goal is to gain insight into the direct effect mechanisms of MIPT by combining outcome measures on both the objective physiological and subjective perception levels. The research questions are directed toward changes in pain experience and heart rate variability and their correlations. Thirty-seven hospitalized patients with chronic or somatoform pain disorders receiving MIPT participated in this study. Demographic data and psychometric measures (Symptom Check List SCL90, Childhood Trauma Questionnaire CTQ) were collected to characterize the sample. Subjective pain experience was measured by McGill Pain Questionnaire (SF-MPQ), and Heart Rate Variability by 24 h-ECG. Data analysis shows a reduction of reported pain from MT1 = 19.1 (SD = 7.3) to MT2 = 10.6 (SD = 8.0) in all dimensions of the SF-MPQ. HRV analyses shows a reduced absolute power during PM and HM, while a relative shift in the autonomic system toward higher vagal activity appears during HM. Significant correlations between HRV and MPQ could not be calculated. Findings are interpreted as a physiological correlate to the psychological processes of the patients. Future studies with more participants, a control-group design, and the integration of medium- and long-term effects are recommended.

Expression of Basic Emotions in Pictures by German and Vietnamese Art Therapy Students - A Comparative, Explorative Study.

During art therapy self-experience workshops in Vietnam and Germany, the authors noticed that there were differences in how the groups expressed their feelings in paintings. This led the authors to a comparative, explorative study. In this study workshop participants from Germany and Vietnam (29 in each group) were instructed to draw pictures related to basic emotions like sadness, disgust, anger, or happiness. Then, the paintings were evaluated by using rating scales with which formal and content-oriented criteria can be assessed. The interrater reliability was good. The results showed some statistically significant differences. The Vietnamese participants used smaller formats and more colors with stronger color application. They preferred simpler forms than the Germans. The German participants painted in a more abstract manner, while the Vietnamese participants used more concrete images and tended to scenic expressions (representation of stories). There are some reasons which might explain these differences: It is known that cultural influences play an important role in the arts as well as in the way creative arts are taught in a particular society. The expression of emotions is culture-specific as well. The Vietnamese participants were, however, interested in the possibilities art therapy offers and felt that there are good chances for this therapy to develop in their country.

Healthy ageing at work- Efficacy of group interventions on the mental health of nurses aged 45 and older: Results of a randomised, controlled trial.

OBJECTIVE: This multicentre, randomised controlled trial (RCT) aimed to evaluate the efficacy of a small-group intervention promoting successful ageing at work in older nurses (aged ≥45). METHOD: A sample of 115 nurses aged ≥45 from 4 trial sites in Germany were randomly assigned to either the intervention group (IG), that received a small-group intervention of seven weekly sessions of 120 min with a booster session after six weeks or to a wait-list control condition (WLC). Outcomes were measured via validated self-report questionnaires at baseline (T1) and at post-treatment (T2). Primary outcomes were mental health-related well-being and mental health-related quality of life (QOL). The secondary outcomes included mental health-related and work-related measures. RESULTS: The intention to treat (ITT) analysis showed significant positive effects of the intervention on mental health. A significant small effect (d = 0.3) in favour of the IG was found for psychological health-related quality of life. Positive small effects (d = 0.24 to d = 0.31) were also found for work related mental strain. CONCLUSIONS: Our small-group intervention based on a theory of successful ageing for nurses aged ≥45 was found to be effective with regard to improvements of psychological health related quality of life and other mental health-related outcomes. Thus, our study shows that the ageing workforce can be reached through specifically designed preventive interventions. The components of our intervention could be easily adapted to the belongings of other professions. Our results suggest that these components should be evaluated in various settings outside the healthcare sector.

Psychosomatic consultation in the workplace: opportunities and limitations of the services offered--results of a qualitative study.

PURPOSE: In Germany, innovative concepts of anchoring psychotherapeutic consultations within an occupational setting emerge in models like the "psychosomatic consultation in the workplace" (PCIW). Characteristic quality is the close cooperation between company-based occupational health physicians (OPs) and external psychotherapeutic consultants. Little is currently known about the attitudes of OPs and other stakeholders in companies in terms of possible contributions of these offers to their tasks within the field of mental health and work. METHODS: Data were collected via individual interviews with different stakeholders (n = 8) and two OP focus groups (each n = 5) with and without experience with PCIW. Data were analysed with content analysis. RESULTS: Common mental disorders (CMD) were perceived as occurring increasingly but still being stigmatized. PCIW allows employees quick access to a neutral psychotherapist and thus might help to avoid chronification of CMD. For companies, this may mean that longer periods of absenteeism (and presenteeism) can be avoided. The interviewees also feel that the ongoing collaboration with a psychotherapeutic specialist may sensitize OPs to recognize mental disorders earlier and provide basic treatment. PCIW was stated as an early, easy and fast first access to psychotherapy. The effort of PCIW is limited if structural changes in the workplace are necessary to reduce mental stressors. Also, if financed by the company, PCIW should have clear time limits and cannot aim to replace health insurance benefits. CONCLUSIONS: Taking above-mentioned limitations into account, PCIW appears to be a promising tool to bridge the gap between OP-conducted company-based health promotion and early secondary care.

The Impact of Event Scale--Revised: evaluation of the subscales and correlations to psychophysiological startle response patterns in survivors of a life-threatening cardiac event: an analysis of 129 patients with an implanted cardioverter defibrillator.

BACKGROUND: The aim of the present study was to examine the reliability and validity of the Impact of Event Scale-Revised (IES-R) with special emphasis on the evaluation of the hyperarousal subscale against a standardized psychophysiological measurement. METHODS: A total of 129 survivors of a life-threatening cardiac event underwent a psychodiagnostic evaluation and a psychophysiological acoustic startle reflex (ASR) paradigm. The ASR assessed the magnitude and habituation of electromyogram (EMG) and skin conductance responses (SCR) in response to the delivery of 15 acoustic startle trials. Pearson correlation and factor analysis was used to measure reliability and construct validity. The hyperarousal subscale was validated against the ASR in terms of sensitivity and specificity mainly using receiver operating characteristic (ROC) curve analysis. RESULTS: A high reliability was found for the intrusion and avoidance subscale (alpha>0.8); however, the hyperarousal subscale showed a weaker reliability (alpha=0.66). No avoidance item, one intrusion item but four hyperarousal items revealed higher correlations to another than its assigned subscale. The hyperarousal subscale was not able to discriminate sufficiently between patients with and without exaggerated startle reactions as indicated by ROC curves running near the diagonal line. LIMITATIONS: The scores in all three subscales are lower compared to subjects traumatized by non-cardiac events. CONCLUSIONS: Reliability and construct validity for the intrusion and avoidance subscale proved to be high but was only sufficient for the hyperarousal subscale. Moreover, the criterion validity of the hyperarousal subscale regarding psychophysiological measurements is arguable and indicates further investigations in this area.

Functional neuroanatomy of grief: an FMRI study.

OBJECTIVE: In this study the authors examined the functional neuroanatomy of grief, which to their knowledge has not been studied previously in functional neuroimaging research. METHOD: Grief was elicited in eight bereaved women through photographs of the deceased versus a stranger, combined with words specific to the death event versus neutral words. Use of both pictures and words resulted in a 2x2 factorial design. RESULTS: Three brain regions were independently activated by the picture and word factors: posterior cingulate cortex, medial/superior frontal gyrus, and cerebellum. The two factors also activated distinct regions: for the picture factor, they were the cuneus, superior lingual gyrus, insula, dorsal anterior cingulate cortex, inferior temporal gyrus, and fusiform gyrus; and for the word factor, they were the precuneus, precentral gyrus, midbrain, and vermis. The interaction of the two factors showed significant activation in the cerebellar vermis. CONCLUSIONS: Grief is mediated by a distributed neural network that subserves affect processing, mentalizing, episodic memory retrieval, processing of familiar faces, visual imagery, autonomic regulation, and modulation/coordination of these functions. This neural network may account for the unique, subjective quality of grief and provide new leads in understanding the health consequences of grief and the neurobiology of attachment.