[Austrian expenditures on psychopharmaceutical drugs between 2006 and 2013]. / Analyse der Ausgaben für Psychopharmaka in Österreich von 2006 bis 2013.

OBJECTIVES: Health costs, which are increasing at a yearly rate of 4 %, represent 11% and thus a large share of Austria's gross domestic product (GDP). High expenditures derive frommental health care costs, including medication. In this article we investigate whether the costs and usage of psychopharmaceutic products in Austria are rising. METHOD: We did a descriptive analysis of the sales figures and number for packaging units of pharmaceutical products of ATC-classes N05 and N06 in all Austrian hospitals, pharmacies and medicine chests for the years 2006-2013. All data were provided free of charge by IMSHealth. RESULTS: The sales volume and number of prescribed packaging units of pharmaceuticals of ATC-classes N05 and N06 increased over the time period in question. In 2013, about 25% more packaging units were being sold than in 2006. Among the two ATC-classes, however, the indication subgroups developed differently. Expenditures increased a total of about 31%within the period of consideration. CONCLUSIONS: The increase in psycho-pharmaceutical sales exceeds the expansion rates of other health expenditures (17.8 %). During the 9 years of observation, 25% more psychopharmaceutical products were sold. This may result from increased prevalence of mental disorders, higher usage or an increment in prescriptions.

The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis.

BACKGROUND: There is strong evidence indicating an interaction between sleep and pain. However, the size of this effect, as well as the clinical relevance, is unclear. Therefore, this meta-analysis was conducted to quantify the effect of sleep deprivation on pain perception. METHODS: A systematic literature search was conducted using the electronic databases PubMed, Cochrane, Psyndex, Psycinfo, and Scopus. By conducting a random-effect model, the pooled standardized mean differences (SMDs) of sleep deprivation on pain perception was calculated. Studies that investigated any kind of sleep deprivation in conjunction with a pain measurement were included. In cases of several pain measurements within a study, the average effect size of all measures was calculated. RESULTS: Five eligible studies (N = 190) for the between-group analysis and ten studies (N = 266) for the within-group analysis were identified. Sleep deprivation showed a medium effect in the between-group analysis (SMD = 0.62; CI95: 0.12, 1.12; z = 2.43; p = 0.015) and a large effect in the within-group analysis (SMD = 1.49; CI95: 0.82, 2.17; z = 4.35; p <0.0001). The test for heterogeneity was not significant in the between-group analysis (Q = 5.29; df = 4; p = 0.2584), but it was significant in the within-group analysis (Q = 53.49; df = 9; p <0.0001). CONCLUSION: This meta-analysis confirms a medium effect (SMD = 0.62) of sleep deprivation on pain perception. As this meta-analysis is based on experimental studies in healthy subjects, the clinical relevance should be clarified.

Guided self-help interventions for irritable bowel syndrome: a systematic review and meta-analysis.

OBJECTIVE: Although irritable bowel syndrome (IBS) is highly prevalent and is accompanied by high costs for respective healthcare systems, the data on treatment effectiveness are limited. Current treatment methods have limitations in terms of side effects and availability. Guided self-help (GSH) might be an easily accessible and cost-effective treatment alternative. This study is the first systematic review and meta-analysis of GSH interventions for IBS. METHODS: Using electronic databases (MEDLINE, SCOPUS, PsycINFO, and Web of Science), we performed a systematic search for randomized-controlled trials. Using a random-effect model, we calculated the pooled standardized mean differences (SMDs) of GSH on IBS symptom severity (primary outcome) and quality of life (secondary outcome). We additionally examined the moderating effects of online-based interventions and face-to-face therapist contact by applying mixed models. RESULTS: A systematic literature search identified 10 eligible randomized-controlled trials, including 886 participants. Compared with the control conditions, the effect size was medium for the decrease in IBS symptom severity (SMD=0.72; 95% confidence interval: 0.34-1.08) and large for the increase in patients' quality of life (SMD=0.84; 95% confidence interval: 0.46-1.22). Neither treatment format nor face-to-face contact was a predictor of therapy outcomes in between-group analyses. In contrast, within-group analyses led to the conclusion that online-based interventions are more effective than other self-help formats. CONCLUSION: GSH is an effective alternative for the treatment of IBS. As GSH methods are easy to implement, it seems sensible to integrate GSH into clinical practice. LIMITATIONS: With respect to the high study heterogeneity, the number of studies included was relatively small.

[How burdensome is the treatment of patients with somatoform disorders?]. / Wie belastend ist die Behandlung von Patienten mit somatoformen Störungen?

OBJECTIVES: This study examines the influence of self-perceived emotional stress during the treatment of patients with somatoform disorders. It asks whether emotional stress can be influenced by psychosomatic education. METHODS: Via online questionnaire general practitioners were asked about the prevalence of patients presenting with somatoform disorders and emotional stress during treatment. RESULTS: The prevalence of somatoform disorders in general practices was estimated at around 27.7 %. Practitioners educated in psychosomatic medicine estimate the prevalence of patients with somatoform disorders higher than practitioners without such education (n = 79; r = 0.242; p = 0.032). The treatment of patients presenting with somatoform disorders causes 42.6% more emotional stress among general practitioners compared with the treatment of an average patient (n = 79; t = 16.67; p ≤ 0.001). Doctors with additional education in psychosomatic medicine rate stress 17.2% lower than doctors without such education (n = 79; t = 1.875; p = 0.033). CONCLUSIONS: General practitioners experience the treatment of patients presenting with somatoform disorders as emotionally stressful. This emotional stress is mainly explained by increases in time expenditure, but it can be reduced by additional psychosomatic education.

[Is there adequate care for patients with psychosomatic disorders in Austria? Analysis of the need and a proposal for a model of quality assurance in Austrian psychosomatic medicine]. / Werden in Osterreich Patienten mit psychosomatischen Storungen ausreichend versorgt? Eine Bedarfserhebung mit Losungsvorschlag zur Qualitats-sicherung fur die Psychosomatische Medizin in Osterreich.

INTRODUCTION: Quality assurance in psychosomatic medicine in Austria is currently based on a voluntary continuing medical education programme in psychosocial, psychosomatic and psychotherapeutic medicine. It is questionable whether psychosomatic care can be sufficiently provided in this manner. In addition, a broadly based proposal to create a subspecialty in psychosomatic medicine in order to facilitate quality assurance, is investigated. METHODS: The necessity to reorganize psychosomatic care was explored through semi-structured qualitative interviews with experts. Data-based analyses probed the labour market of the proposed subspecialty, and the literature was reviewed to look into the cost-benefit ratio of psychosomatic treatment. RESULTS: All experts expressed a need to restructure psychosomatic care in Austria. Examples exist for psychosomatic treatment with an efficient cost-benefit relation in diverse medical settings. CONCLUSION: Establishing a subspecialty in Psychosomatic Medicine seems feasible and could contribute to increased quality assurance and the nationwide provision of psychosomatic care.

Health, self-regulation of bodily signals and intelligence: review and hypothesis.

Childhood IQ and adult morbidity and mortality are known to be linked even beyond socioeconomic variables. Yet, their interrelations are insufficiently understood. It has been suggested that bodily sensations play a fundamental role in health-related self-regulation and that intelligence can influence the information processing of these somatic signals. This assumption is supported by reports on the influence of IQ on the exteroceptive (e.g. visual and auditory) and interoceptive (e.g. autonomic nervous system and posture) perception and processing of somatic information. Based on these findings the hypothesis of Psychosomatic Intelligence (PI) is introduced as an additional conceptual framework to probe the link between childhood IQ and adult health status. It implies a specific cognitive ability concerning the perception, interpretation, and self-regulation of bodily sensations. In this model, somatic signals are considered to reflect both intra-individual processes and individual-environment interactions. Based on this hypothesis the influence of intelligence on cognitive efforts to self-regulate somatic phenomena is amenable to systematic testing.

[Evaluation of a two year curriculum in psychosocial and psychosomatic medicine--handling emotions and communicating in a patient centred manner]. / Evaluation eines zweijährigen Curriculums in Psychosozialer und Psychosomatischer Medizin--Umgang mit Emotionen und patientenzentrierter Gesprächsführung.

Psychosomatic Medicine is aiming at a comprehensive understanding of patient's requests. This requires patient-centred communication. During the two-year course for "Psychosomatic Medicine"of the Lower-Austrian Medical Chamber at the Danube-University Krems relevant techniques are trained. This paper reports on the analysis of 120 video-consultations with simulated patients (30 participants, two per participant before and after the training) using a modified version of the Roter Interaction Analysis System (RIAS). Results show a considerable increase in participant's ability to respond to emotional utterances and to use techniques of patient-centred communication: percentage of appropriate utterances related to the sum of all utterances: from 9.78 ± 3.5 to 13.56 ± 4.7 (ANOVA with repeated measures: p<0.001). Furthermore, participants allow patients longer stretches of uninterrupted speech: increase from 1.76 ± 1.4 to 2.47 ± 2.3 utterances (p<0.001) helping them into a narrative style of conversation.

[Life satisfaction--a dimension of psychotherapeutical prevention. Critical reflections and results of empirical research]. / Lebenszufriedenheit--eine Dimension psychotherapeutischer Prävention. Kritische Einwürfe und empirische Befunde.

Psychotherapy has historically been developed on ill people and is applied in the system treating the sick. A healthy person who has no complaints is only in exceptional cases the subject of psychotherapeutic inquiries as to his/her experiences and behaviour. In this article, the pathologising basic attitude is abandoned and the appreciation of one's own life over one's lifetime and the accompanying complex possibilities of prevention are given. The empirical findings provided cover areas of life which show impairment and in which psychotherapy can cause positive changes. Assessments of life contentment are shown by means of various psychotherapeutic methods. The conclusion is that psychotherapy aims at a "productive therapeutic" change with immediate consequences of application.