Psychological resilience and intolerance of uncertainty in coping with cystic fibrosis.

BACKGROUND: Anxiety and depression are lower than to be expected in a considerable portion of cystic fibrosis (CF) patients. This outcome might be a result of substantial resilience and/or tolerance of uncertainty in coping with adversity. Research into resilience in cystic fibrosis is in its infancy. METHODS: 57 adult CF patients participated in the study during their routine medical checkup. In addition to regular psychological assessment, the Intolerance of Uncertainty Scale (IUS) and the Resilience Scale (RS) were administered. The relative importance of IUS and RS in predicting quality of life in CF was explored. Bivariate correlations and predictive value of variables in multiple regressions on subscales of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) were calculated. RESULTS: Remarkably, resilience (personal competence and acceptance) was clearly elevated, whereas intolerance of uncertainty was comparable to healthy reference groups. In multiple regressions, personal competence emerged as strongest resilience variable in the prediction of quality of life. CONCLUSIONS: CF patients in our study seem to be particularly resilient rather than cognitively avoidant. At this stage of research, fostering personal competence in CF patients is most promising in improving quality of life.

Evaluating patient experience in a cystic fibrosis centre using a disease-specific patient satisfaction questionnaire.

UNLABELLED: Medical care for persons with chronic diseases like cystic fibrosis (CF) is provided by multi-professional teams. We assessed the patients' perspective of care by reporting the results of two consecutive patient satisfaction surveys performed within a 2-year interval at our CF centre. The newly developed, disease-specific questionnaire for parents and adults had 104 items with up to 6 response categories each. For data analysis, responses were dichotomized into a problem score with 0 % as the ideal result. Adolescents were surveyed using a different questionnaire. Seventy-six and 89 respondents, respectively, took part in the 2009 and 2011 surveys (response rates: 72 to 84 %). In 2009, the ideal problem score of 0 % was reported for 18 and 20 % of all items in adults and parents, respectively. Thirteen items had a problem score >30 %. After the whole team had implemented quality improvement measures, the 2011 survey showed a >10 % decrease in problem scores for 11 and 21 % of items in the adults and parents groups, respectively. Adolescents also reported better experiences in 2011 than in 2009. CONCLUSION: Exploring the patients' perspectives aids to identify strengths and weaknesses and helps to provide patient-centred care, which is important for persons with chronic illness.

[The influence of relationship dynamics on the psychosocial outcome of genetically related and unrelated living kidney donor-recipient pairs]. / Einfluss von beziehungsdynamischen Aspekten auf den psychosozialen Outcome von genetisch verwandten und nicht-verwandten Nierenlebendspendern und-empfangern.

OBJECTIVES: Renal diseases and their treatment can cause distress and psychosocial problems for both patients and relatives. METHODS: Relationship dynamics and parameters of quality of life were assessed in 10 genetically related (brothers) and 14 genetically unrelated donor-recipient pairs (spouses) involved in living kidney donation (LKD). RESULTS: LKDs were described by related donors and recipients as fundamentally positive and in many cases led to an intensification of the relationship between donor and recipient. LKDs between unrelated donors and recipients appeared to achieve the same results as donations between related donors and recipients. Particularly the general desire to help determined the decision-making process of donors. CONCLUSION: In addition to general clinical parameters, especially motivational and relationship dynamics should be evaluated in the pre- and postoperative clinical psychological assessment of potential donors and recipients of LKD.

Guiding principles on how to manage relevant psychological aspects within a CF team: interdisciplinary approaches.

Managing CF can be emotionally and physically challenging for patients and their relatives. The disease and its treatment influence the ability to tackle normal tasks of daily living and unexpected life events. The context within which psychologists work varies according to different cultural backgrounds and their professional and theoretical memberships. The benchmarks presented here focus on four crucial issues: (i) identifying a common base of tools and theoretical reflections through suggested readings, (ii) interdisciplinary work within a CF team and its importance for both persons with CF and other healthcare professionals, (iii) the benefits of an eclectic approach utilising cognitive-behavioural theories for specific psychological problems and, (iv) effective and evaluated transition programmes from paediatric to adult healthcare services.

[A dimensional diagnostic approach using the "Assessment of DSM-IV Personality Disorders (ADP-IV)" Questionnaire]. / Dimensionale Diagnostik mit dem Fragebogen zur Erfassung von DSM-IV-Persönlichkeitsstörungen (ADP-IV).

OBJECTIVES: The ADP-IV is a self-assessment instrument of personality disorders providing categorical as well as dimensional diagnoses. The German translation of the Dutch original has already shown sufficient reliability as well as a rather weak convergent validity of categorical diagnoses. This study investigates the validity of the dimensional assessment of personality disorders. METHODS: Four hundred patients and a community sample of 385 subjects completed the ADP-IV. A SCID-II interview and an expert consensus rating were also performed in 210 patients. Norms for patients and the community sample were calculated by using z-transformation. Receiver operator curves (ROC) were employed for the determination of cut-offs for categorical diagnoses on the basis of the dimensional scores. RESULTS: The ROC analyses resulted in negative predictive values of 99 % for the five most frequent personality disorders in the sample; in contrast, positive predictive values were low. CONCLUSIONS: The instrument is well suited for screening purposes, allowing for a reliable exclusion of personality disorders. For diagnosing personality disorders, however, clinical interviewing remains necessary. Norms and a dimensional personality disorder profile provide hints concerning the presence of pathological personality traits with respect to the reference group. The ADP-IV represents the only German-language questionnaire for the assessment of DSM-IV personality disorders which has been sufficiently validated. It is freely available on the internet at http://zmkweb.uni-muenster.de/einrichtungen/proth/dienstleistungen/psycho/diag/index.html.

[Validation of the "Assessment of DSM-IV Personality Disorders (ADP-IV)" Questionnaire]. / Validierung der deutschen Version des Fragebogens zur Erfassung von DSM-IV Persönlichkeitsstorungen (ADP-IV).

OBJECTIVES: The "Assessment of DSM-IV Personality Disorders (ADP-IV)" represents a 94-item questionnaire that allows for a categorical and dimensional assessment of the DSM-IV personality disorders. METHODS: Psychometric properties of the German ADP-IV were investigated in 400 psychotherapy outpatients and a community sample of 385 persons. The SCID-II interview and a standardised expert consensus rating were employed for the assessment of concurrent validity. RESULTS: The ADP-IV showed satisfactory reliability; the median Cronbach's alpha for the subscales was .76 (range .65-.87), the median retest reliability .79 (range .37-.88). Factor analysis revealed an 11-factor solution that explained 49.4% of the variance. The median correlation of the dimensional ADP-IV subscale scores with the SCID-II and the expert consensus ratings were .51 (range: .34-.72) and .44 (range: .27-.62), respectively. The kappas for the chance corrected agreement of categorical ADP-IV diagnoses with the SCID-II diagnoses and the expert ratings were .35 and .29 for any personality disorder and a median of .37 and .30 for the specific personality disorders. CONCLUSIONS: The ADP-IV shows satisfactory reliability and a validity that is comparable and partly superior to other self-rating instruments. The advantages of the instrument are its brevity, the inclusion of distress ratings, and the dimensional scoring that allows for the construction of detailed profiles of personality pathology. Moreover it is freely available in the internet: (http://zmkweb.uni-muenster.de/einrichtungen/proth/dienstleistungen/psycho/diag/index.html).

[Predictors of successful psychotherapy referral in a psychotherapy outpatient clinic and subsequent psychotherapeutic outcome]. / Prädiktoren des Uberweisungserfolgs einer psychotherapeutischen Klinikambulanz und des späteren Therapieverlaufs.

OBJECTIVES: Many patients are referred to psychotherapy by outpatient units of psychiatric hospital departments. This study investigates predictors of success and outcome of subsequent psychotherapy in this group of patients. METHODS: Two years after referral, 140 out of an initial sample of 215 patients of a psychotherapy outpatient unit were followed up by means of a telephone interview and questionnaires (GHQ, IIP). In addition, their therapists were interviewed. RESULTS: 57.1% of the patients actually began psychotherapy; of these, 67.5% completed or were continuing the treatment. Predictors of referral success were younger age, female gender, higher levels of depression, a less competitive, subassertive, nurturant, and expressive personality style, and a preexisting high motivation for psychotherapy. In the total sample of 140 patients there was a significant improvement of psychopathology (0.54 < d < 0.99), interpersonal problems (0.25 < d < 0.33), and subjective experience of symptoms (d = 0.26). Patients who began psychotherapy did not show a significantly better outcome after two years compared to those who were non-compliant. CONCLUSIONS: Randomized-controlled studies are not comparable to regular outpatient treatment. Patients who did not begin psychotherapy despite referral might have been stabilized by the initial brief intervention they received at the psychotherapy outpatient unit, and consequently did not feel the need for any additional psychotherapy. This group of patients should be identified before being referred and offered a short-term psychotherapy at the outpatient unit.