[Sleep disorders reduce the therapeutic success of inpatient psychosomatic treatments for depressive disorders]. / Schlafstörungen verringern den Therapieerfolg stationärer psychosomatischer Behandlungen bei depressiven Störungen.

Sleep disorders reduce the therapeutic success of inpatient psychosomatic treatments for depressive disorders Objective: What influence do difficulties in falling and staying asleep in patients with depressive disorders have on the success of psychosomatic treatment? Method: The Data were collected in a naturalistic, multicenter observational study (STOP-D) at the beginning (T1), the end (T2) and six months later after discharge (T3). The sample consisted of female patients with depressive disorders (N = 487) who were treated for M = 61.7 days (SD = 26.8). An insomnia scale with a total of seven items was created subsequently to T1 from Items of the Beck Depression Inventory (BDI-I), from the Hamilton Depression Scale (HAMD) and from the Global Severe Index (GSI) from the Symptom Checklist 90 (SCL-90-R). Then groups were formed on changes in insomnia symptoms from T1 to T2. These two groups "sleep improver" and "sleep deteriorators" were tested by analysis of variance. Results: The subsequently constructed insomnia scale showed good psychometric characteristics in the performed analyses. Patients who reported an improvement in their sleep disturbances during inpatient psychosomatic treatment had significantly lower depression scores in the self-evaluation inventories (BDI-I und SCL-90-R) than patients without improvements in their sleep patterns. This effect was even more pronounced for the catamnestic period. Discussion: Insomnia symptoms in depressed female patients can be an important indicator of the effect of inpatient psychosomatic treatment and can have negative impact on the sustainability of the therapy success.

[Long-Term Patterns of Depressive Symptomload and their Predictors in Hospitalised Patients Undergoing Psychodynamic Psychotherapy: Findings of the STOP-D Study]. / Langzeitverläufe depressiver Symptomlast und deren Prädiktoren bei stationärer, tiefenpsychologisch fundierter Psychotherapie: Befunde der STOP-D-Studie.

OBJECTIVE: Depression is one of the most common mental disorders. While the general effectiveness of in- and outpatient psychotherapy is proven, different long-term patterns in treatment of symptoms of depression have been described. The aim of the present study was to show different patterns of benefit in the context of inpatient psychodynamic psychotherapy of depressive disorders and to detect predictors of different types of response that help to identify possible non-responders and adjust treatments accordingly. METHODS: Data of the naturalistic multicentre intervention study were collected in 15 German psychosomatic hospital units employing a predominantly psychodynamic approach to treatment. The sample includes n=432 patients (women: age 25-45 years) with typical symptoms of depression. The patterns of outcome were identified using a latent state model with a method factor and a latent class analysis; potential course predictors were analysed using regression analysis. RESULTS: Three long-term patterns of outcome were identified: patients with significant treatment benefit, whose symptom decline was stable even in a 6-month catamnesis (Responders: 76.9%), patients without a significant symptom decrease during treatment and in the follow-up survey (Non-responders: 18.8%), as well as patients with a significant symptom decrease but showing an increase of symptoms in the catamnesis (Backsliders: 4.4%). The severity of baseline depressive symptom load was determined as a predictor for the pattern of Backsliders. Non-responders differed from responders in having had psychosomatic pre-treatments more frequently. DISCUSSION: In the case of backsliders, further studies should, for instance, verify whether relapses can be explained by the patient's symptoms, treatment, or social environment. In the case of non-response due to numerous unsuccessful pre-treatments, the question arises whether psychosomatic treatment offers the right setting for these patients or how therapy settings should be modified. CONCLUSION: Long-term patterns reported in the literature were partially confirmed. There are indications of an influence of the initial symptom-load severity on the outcome of treatment. It is important to consider how treatment settings can be modified accordingly.

A Bifactor Model of Personality Organization.

The aim of this study was to explore the viability of a bifactor model for the Inventory of Personality Organization (IPO), which is a self-report measure of personality functioning based on Kernberg's model of personality organization. A heterogeneous, predominantly clinical sample (N = 616) completed the German 83-item version of the IPO. Confirmatory and Exploratory Factor Analyses were applied to explore the factor structure of the IPO. We were able to establish a bifactor model with a general factor of personality functioning and three specific factors (Aggression, Reality Testing, Moral Values), which represent additional dimensions of personality organization. Virtually all items showed substantial positive loadings on the general factor, explaining roughly 66% of the common variance. Furthermore, we found support for convergent and discriminant validity of general and specific factors with regard to interview-based assessments of personality disorders and personality organization. The results lend support to a bifactor approach to Kernberg's model of personality organization. We also present a 30-item brief form of the IPO that efficiently implements the bifactor approach and may be further validated in future studies.

[Long-term effectiveness of psychodynamic inpatient therapy on depressive disorders - Catamnestic- Results of the STOP-D-Study]. / Langzeiteffekte tiefenpsychologisch fundierter stationärer Psychotherapie bei Depressionen ­ Katamnesebefunde der STOP-D-Studie.

Long-term effectiveness of psychodynamic inpatient therapy on depressive disorders - Catamnestic- Results of the STOP-D-Study Objectives: Depression is one of the most common disorders with a rate of recurrence between 60-75 %. The effectiveness of psychodynamic therapy is well-proven, but there is still a lack of studies proving the long-term effectiveness of inpatient treatment on depressive symptom load. Methods: After psychodynamic inpatient treatment in a psychodynamically oriented psychosomatic hospital unit, the reduction in general and depressive symptom load (e. g. BDI, HAMD, SCL-90-R) was evaluated by a six-month follow up design. The study was set up as naturalistic multicenter intervention study including a female follow-up sample (N = 291; age 25-45 years). Results: The symptom improvement reached by the inpatient treatment remained stable at the follow-up survey. Patients treated with antidepressant medication showed stronger depressive symptom load at discharge and follow-up survey compared to patients without antidepressant medication. Sociodemographic variables and a comorbid personality disorder were not associated with increased drop-out rates, but depressive symptom load and a premature ending of the treatment. Conclusions: The obtained results demonstrate the long-term effectiveness of inpatient psychodynamic psychotherapy. Further studies about the influence of post-hospital psychotherapy and medical treatment as well as patient satisfaction seem necessary.

[Depression and Comorbid Personality Disorder - Effectiveness of Psychodynamic Inpatient Psychotherapy]. / Depression und komorbide Persönlichkeitsstörung ­ Effekte stationärer tiefenpsychologisch fundierter Psychotherapie.

Objectives Depression is one of the most common illnesses. The effectiveness of psychodynamic psychotherapy on depressive symptom load has been demonstrated. However, for patients suffering from comorbid personality disorder (PD) a decreased benefit has been reported, as well as fewer rates of remission and extended duration of remission. However, findings are inconsistent. The objective of this study was to determine potential differences in therapy-outcome comparing female patients with and without comorbid PD. Method Including female inpatients aged between 25-45 years (N=377) in a psychodynamic treatment, the dissenting outcome on depressive symptom load (among others BDI; HAMD) as well as psychodynamic variables (IPO) by patients with and without comorbid PD were analysed within a naturalistic multicenter intervention study (STOP-D). Data were collected in 15 psychodynamically oriented psychosomatic hospital units in Germany, based on self- and external-assessment instruments. Results Under comparable therapy-doses, female patients with and without comorbid PD benefit significantly from psychodynamic inpatient treatment. By equivalent baseline severity of clinical symptoms patients without comorbid PD show larger effect sizes in all inventories than patients with comorbid PD. Discussion Although the benefit is lower for depressed patients with comorbid personality disorder, the positive effect of inpatient psychodynamic psychotherapy is statistically and clinically significant in both groups. Influences of further comorbid symptoms and confounding symptoms between depression and PD, which were difficult to control, are possible. Further studies are necessary. Conclusion Although patients with comorbid PD benefit significantly from the inpatient treatment, a special therapeutic design seems to be indicated for these patients.

[Psychodynamically oriented inpatient psychotherapy of depressive disorders - First findings from a naturalistic, multicenter study]. / Stationäre tiefenpsychologisch orientierte Psychotherapie bei depressiven Störungen (STOP-D) - Erste Befunde einer naturalistischen, multizentrischen Wirksamkeitsstudie.

OBJECTIVES: While the general effectiveness of psychodynamic psychotherapy in both outpatient and inpatient treatment has been proven, few studies document the effectiveness of clinical inpatient treatment of depression through psychodynamic psychotherapy. METHODS: This paper presents first results of a naturalistic multicenter intervention study. Included were female inpatients suffering from depressive symptoms who had been admitted to 15 psychodynamically oriented psychosomatic hospital units (N = 487). The mean duration of treatment was 61.8 days. Data were acquired at admission (T1) and discharge (T2). RESULTS: Our findings support previous evidence and show that psychodynamically oriented inpatient psychotherapy of depressive disorders is efficient. High pre-post effect sizes were documented in all psychometric instruments used (BDI, HAM-D, SCL-90-R, BSS, GAF). Initial subgroup comparisons reveal that the benefits for patients with comorbid personality disorder are significantly lower than for depressed patients without comorbid personality disorder. CONCLUSION: Psychodynamic inpatient psychotherapy, as practiced under naturalistic conditions, is an effective treatment of depression. Predictors of therapeutic effects within different therapeutic settings, however, remain unclear. The sustainability of the therapeutic effects found and their impact on psychodynamic relevant constructs have still to be proven.

Evaluating an evidence-based curriculum in undergraduate palliative care education: piloting a phase II exploratory trial for a complex intervention.

BACKGROUND: By 2013 Palliative Care will become a mandatory examination subject in the medical curriculum in Germany. There is a pressing need for effective and well-designed curricula and assessment methods. Debates are on going as how Undergraduate Palliative Care Education (UPCE) should be taught and how knowledge and skills should be assessed. It is evident by this time that the development process of early curricula in the US and UK has led to a plethora of diverse curricula which seem to be partly ineffective in improving the care for the seriously ill and dying offered by newly qualified doctors, as is demonstrated in controlled evaluations. The goals of this study were to demonstrate an evidence-based approach towards developing UPCE curricula and investigate the change in medical students' self-perceived readiness to deal with palliative care patients and their families. METHODS: To evaluate the effects of the UPCE curriculum we chose a prospective, controlled, quasi-experimental, pre, retrospective-pre, post study design. A total of n = 37 3rd and 4th -year medical students were assigned to the intervention group (n = 15; 4th -year) and to the control group (n = 22; 3rd-year). Resting on the self-efficacy concept of Bandura the measurement was conducted by a refined test-battery based on two independent measurements (the revised Collet-Lester-Fear-of-Death-Scale and the instrument of the "Program in Palliative Care Education and Practice" at Harvard Medical School) including 68 items altogether in a five-point Likert-scale. These items were designed to test elementary skills in caring for the dying and their relatives as perceived by medical undergraduates. Datasets from both groups were analysed by paired and independent two-sample t-test. The TREND statement for reporting non-randomized evaluations was applied for reporting on this quasi-experimental study. RESULTS: Three constructs showed statistically significant differences comparing the intervention group before and after. Willingness to accompany a dying patient increased from 21.40 to 37.30 (p < .001). Self-estimation of competence in communication with dying patients and their relatives increased from 12.00 to 23.60 (p = .001). Finally, self-estimation of knowledge and skills in Palliative Care increased from 8.30 to 13.20 (p = .001). CONCLUSIONS: This study is a small but systematic step towards rigorous curricular development in palliative care. Our manualised curriculum is available for scrutiny and scientific feedback to support an open and constructive process of best-practice comparison in palliative care.