RESUMEN
Clinical diagnostics of mental disorders especially among refugees and asylum seekers come with unique difficulties: language barriers, different forms of expression and concepts of the understanding of mental illness as well as a different cultural background. Therefore professional interpreters are needed but associated with a higher effort related to costs and time. We conducted a retrospective analysis of costs, which incurred by the use of professional interpreters in our outpatient clinic in Berlin, Germany, in the first quarter 2016 for the treatment of refugees and asylum seekers. The sample consisted of 110 refugees and asylum seekers; the highest costs in the use of interpreters incurred among Neurotic, stress-related and somatoform disorders (53.04%), especially Posttraumatic Stress Disorder (39.04%), as well as affective disorders (38.47%), especially major depressive episodes (25.23%). Our data point out the crucial need of a regulation of costs with regard to the service of professional interpreters in Germany.
Asunto(s)
Asistencia Sanitaria Culturalmente Competente/economía , Costos de la Atención en Salud/estadística & datos numéricos , Trastornos Mentales/economía , Trastornos Mentales/terapia , Servicio Ambulatorio en Hospital/economía , Refugiados/psicología , Traducción , Berlin , Barreras de Comunicación , Costos y Análisis de Costo , Etnopsicología/economía , Hospitales Psiquiátricos/economía , Trastornos del Humor/economía , Trastornos del Humor/terapia , Programas Nacionales de Salud/economía , Trastornos Neuróticos/economía , Trastornos Neuróticos/terapia , Estudios Retrospectivos , Trastornos Somatomorfos/economía , Trastornos Somatomorfos/terapia , Trastornos por Estrés Postraumático/economía , Trastornos por Estrés Postraumático/terapiaRESUMEN
In 1965, the effectiveness of psychoanalytic therapy was demonstrated, which was then included in the reimbursement schemes of the statutory health insurance. In 1987, epidemiologic evidence was provided for the high prevalence of psychosomatic diseases, often associated with a high risk load. Later a phase model described the effects of psychotherapy by the successive levels of remoralisation, symptom and functional improvement. On the basis of health insurance data Felliti (2002) provided plausible evidence for the psychosocial aetiology of most chronic somatic diseases. These data correspond to a dramatically reduced life expectancy. Thus, a causal bio-psycho-social chain exists between adverse childhood events (ACE), unspecific bodily tensions, dysfunctional health-related coping behavioural strategies (risk load), serious chronic diseases and premature death. In summary, psychosomatic medicine and psychotherapy is a field of health care with a variety of target dimensions which can be brought together in an appropriate model.
Asunto(s)
Trastornos Psicofisiológicos/psicología , Psicoterapia/normas , Emociones , Femenino , Alemania/epidemiología , Humanos , Masculino , Modelos Psicológicos , Trastornos Neuróticos/economía , Trastornos Neuróticos/psicología , Trastornos Neuróticos/terapia , Psicoanálisis/economía , Psicoanálisis/normas , Trastornos Psicofisiológicos/economía , Trastornos Psicofisiológicos/epidemiología , Trastornos Psicofisiológicos/terapia , Psicoterapia/economía , Mecanismo de Reembolso , Conducta SexualRESUMEN
Under certain circumstances patients who are receiving compensation for an injury will have a disproportionate disability and delayed recovery because of reinforcers provided by the accident. Successful treatment depends on early recognition that the primary problem is emotional rather than due to concurrent physical problems. A few general rules can be helpful in the diagnosis and treatment of this type of patient. A thorough psychosocial history should be taken, and return to work as soon as possible is essential. With awareness of this process, the physician can work with the company, the therapist, and other consulting physicians to minimize the patient's disability and to maximize recovery.