[Patients' perspectives on behavioral and cognitive changes after hospitalization: a 3-month follow-up cohort study using qualitative and quantitative research methods]. / Verhaltens- und Einstellungsänderungen nach Behandlung auf einer internistichen beziehungsweise internistisch-psychosomatischen Akutstation - eine qualitative und quantitative naturalistische Katamnesestudie.

OBJECTIVES: To describe patients' subjective perspectives on hospitalization at time of admission, to prospectively investigate patients' views on changes actually achieved after discharge, and to identify predictors of subjective changes 3 months after hospitalization. METHODS: We conducted a 3-month follow-up cohort study using qualitative and quantitative research methods. Consecutive adult inpatients of an internal medicine ward and a ward integrating internal and psychosomatic medicine were included. They answered open-ended questions concerning their motivation for change at the time of admission (N = 639) using self-report questionnaires and 3 months post hospitalization via a telephone interview (N = 389). Qualitative content analysis was performed. Predictors of subjective change 3 months after hospitalization were identified using multivariate logistic regression analyses. RESULTS: At admission, more psychosomatic patients than internal-medicine ward patients wanted to achieve change (58% vs. 44 %). Patients expressed desires that were assigned to three main categories: to pay more attention to one's physical health (40 %), to change one's perceptions (32 %), and to change one's way of life (16 %). Three months after discharge, 52 % of patients had experienced cognitive and behavioral changes they attributed to their hospitalization. 31 % of the patients reported continuing to implement changes that had begun during hospitalization. Predictors of subjective change 3 months after hospitalization included high educational level (OR = 2.04, 95 %-CI 1.27-3.26), young age (OR = 0.98, 95 %-CI 0.97-1.00), and length of hospitalization (OR = 1.03, 95 %-CI 1.00-1.05). CONCLUSIONS: There is considerable motivation for behavioral and cognitive change among inpatients following admission; this deserves the attention of healthcare professionals. An integrated psychosomatic setting would appear to support cognitive and behavioral changes more effectively than a classical internal medicine ward.

Development of a group therapy to enhance treatment motivation and decision making in severely obese patients with a comorbid mental disorder.

BACKGROUND: The prevalence rate of mental disorders in severely obese patients appears to be high. In the Department of Psychosomatic Medicine, Heidelberg, we established a short outpatient group intervention for severely obese patients with an affective, anxiety, and/or eating disorder who either are not able to make a clear decision for an intensive weight loss program or who have already decided to undergo bariatric surgery but are advised to attend a support group before surgery. The aim of the group intervention was to reduce depressive symptoms and, in indecisive patients, to enhance the motivation of the patients for engagement in further intensive treatment programs, including bariatric surgery. METHODS: Descriptive data of the first two intervention groups are provided. The treatment program and topics of the group sessions are explained. Time series analysis methods are used to investigate the development of a single patient during the intervention program. RESULTS: Initially, 16 patients joined the group program; ten of these attended the group therapy to completion. The remaining ten patients showed clinically relevant reduction in depression levels and improvement in mental quality of life. Results of the single-case time series analysis indicate that the temporal relationship between eating behavior and depression changed during treatment. CONCLUSIONS: The group program, as outlined, could be a useful intervention for severely obese patients with comorbid depression, anxiety, or eating disorder. A gap in the health care system is thus bridged by this short intervention that can encourage further treatment decisions such as bariatric surgery.

[Crash course "clinical research in psychosocial medicine": changes in research knowledge and subjective research competence]. / Intensivkurs Klinische Forschung in der Psychosozialen Medizin": Veränderungen von Forschungswissen und subjektiver Forschungskompetenz.

In the field of psychosocial medicine, there is a lack of structured training programs in clinical research methodology for young investigators. This study investigates changes in research knowledge and subjective research competence during a one-day crash course in clinical research. In addition, the participants evaluated the quality of the course. The crash course, held at the 2007 meeting of the German Council of Psychosomatic Medicine, consisted of 10 lessons regarding clinical study design, biostatistics, and publication of study results. Changes in research knowledge and subjective research competence were measured with multiple-choice and open-ended questions using a one-group pre-post-test-design. All 11 participants (73 % male, mean age 37.0 +/- 9.5 years) completed the evaluations at the beginning and at the end of the course. The crash course was associated with a significant increase in research knowledge (effect size = 1.3; p < 0.001), but no significant change was found with respect to subjective research competence (effect size = 0.2; p = 0.52). Overall, the quality of the course was rated as excellent; 10 of the 11 participants (91 %) would participate again in a similar crash course. The substantial increase in research knowledge suggests that structured courses in clinical research methodology should regularly be offered to young investigators, e. g. within the scope of research meetings or other national structures.

[Elevated costs of treatment in medical inpatients with psychiatric comorbidity are not reflected in the German DRG-system]. / Höhere Kosten bei internistischen Krankenhauspatienten mit psychischer Komorbidität: Fehlende Abbildung im DRG-System.

OBJECTIVE: So far, it remains unclear whether treatment of psychiatric comorbidity in medical inpatients is appropriately reflected in the German Diagnosis-Related Groups (DRG) system. Therefore, we investigated the relationship of psychiatric disorders and costs, returns, net gain, and duration of hospitalization in internal medicine inpatients. METHODS: For a period of 1 year, we analyzed costs, net gain and other outcome variables according to the DRG system for all inpatients of a university department of internal and psychosomatic medicine (n = 697). Psychiatric disorders were diagnosed by the treating physicians based on clinical criteria and results from the Patient Health Questionnaire (PHQ). With respect to the outcome variables, we compared three groups of patients with none, one, and more than one psychiatric disorder controlling for sociodemographic characteristics. RESULTS: The average total costs of the hospitalization (M +/- SD) for internal medicine patients without psychiatric comorbidity (4357 +/- 5312 euro), for patients with one psychiatric disorder, (4733 +/- 5389 euro), and for patients with more than one psychiatric disorder (7163 +/- 8277 euro) differed significantly (p = 0.0003). However, the increased costs for patients with psychiatric comorbidity were not related to elevated returns: the net gain for patients without psychiatric comorbidity was 457 +/- 2884 euro; in contrast, the treatment of internal medicine patients with one and more than one psychiatric disorder resulted in a net loss of - 260 +/- 2389 euro and - 348 +/- 3370 euro, respectively (overall group difference, p = 0.03). CONCLUSIONS: Additional work and expenses caused by patients with psychiatric comorbidity should be documented and reflected in the revenue systems. Practical self-report screening questionnaires may help to detect and treat psychiatric disorders in internal medicine inpatients as early as possible.