Self-report versus interview data of women's subjective theories of illness: concordance and predictive validity in a psychosomatic-gynecological liaison service.

Between-method comparisons of patient data from standardized self-report instruments and corresponding patient interview data frequently have poor agreement. We investigated the concordance and predictive validity of self-report measures and expert-rated interview data of women's subjective theories of illness in a psychosomatic-gynecological consultation liaison service. 31 patients completed two questionnaires (KKG, PATEF) on subjective theories of illness and were interviewed with a semistructured instrument on the same topic at the time of the initial appointment and after 1.5 years. External criteria for assessing the predictive validity of questionnaire versus interview data were: follow-up participation and psychotherapy utilization during the follow-up interval. Questionnaire and interview rating data were only modestly associated. Rater concordance on the interview data was low. Neither the initial-assessment interview nor the questionnaire data had predictive validity for patients' participation in the follow-up. None of the interview rating data but a portion of the questionnaire data, had predictive validity for patients' utilization of psychotherapy during the follow-up interval. The cognitive conceptualization of subjective theories of illness may fail in patients with psychosomatic disorders, due to their very mode of experience. A wider approach that includes assessment of nonverbal communication and countertransference might be useful.

Gender and perversion--what constitutes a "bad mother".

BACKGROUND: There is a need for reconsidering the conceptualisations of female perverse behavior, especially in connection with motherhood. METHODS AND FINDINGS: Based on case material obtained through psychoanalytic psychotherapy with female patients from a psychosomatic gynecological outpatient clinic, the characteristics of the psychic structure of these patients who presented symptoms of deliberate self harm and of misusing and mistreating their children, are outlined. Another common trait is the embeddedness of their perverse behavior in a generational chain of transmission. Female patients who mistreat their children had been victims of traumatising experiences in their own biography, inflicted by their mothers and directed towards their bodies. DISCUSSION: Female perverse behavior, therefore, is fundamentally different from male perversion: the perverse act in women is aimed against themselves and/or their children. Currently used diagnostic statistical manuals lack categories to describe this symptomatology adequately. Further research is requested to understand a mother's perverse actions and thus develop treatment strategies, without marginalizing these patients.

Medical students' attitudes towards psychotherapy: an intervention-based pre-post comparison.

BACKGROUND: Despite a wealth of studies on medical students' attitudes towards psychiatry in general, little is known about their specific attitudes towards psychotherapy. There is no evidence on the flexibility of these attitudes in the context of a curriculum-implemented psychotherapy information session. OBJECTIVES: To assess medical students' attitudes towards psychotherapy and short-term flexibility therein, with an introductory course on psychotherapy as the relevant intervention for this pre-post comparison. METHODS: A random sample of 159 advanced medical students completed a short questionnaire before and after a short course on psychotherapy. The questionnaire consisted of indirect attitude measures towards psychotherapy (associations and connotations), a likelihood rating for future training in psychotherapy, a statement about one's most preferred medical specialty for one's future career, and basic demographics. RESULTS: Participants' pre-interventional connotations of psychotherapy were predominantly positive. In the pre-post comparison, more than one third of the connotation measures shifted substantially and favorably. Post-interventionally, participants' distinctive static word association style regarding psychotherapy was attenuated in favor of a more differentiated style and an enlarged field of associations. The data are suggestive of significant pre-interventional sex differences, with females holding more positive views towards psychotherapy and reporting a greater likelihood of future psychotherapeutic training. The data also suggest that the intervention acted differently upon the sexes. Likelihood ratings for future training in psychotherapy did not decline after the course, despite the fact that the cost and duration of training were mentioned in the course. CONCLUSIONS: Even minimal educational interventions can enhance medical students' predominantly positive attitudes towards psychotherapy. This finding calls for further implementation of psychotherapy-related material in medical curricula.

[Psychic effects of an adjuvant hormone replacement therapy in premenopausal patients: influence on the quality of life]. / Psychische Auswirkungen einer adjuvanten Hormonersatztherapie bei prämenopausalen Patientinnen: Einfluss auf die Lebensqualität.

The influence of acute and chronic affects on hormonal activities via the neuropeptides is beyond speculation: for some women, times of hormonal changes are more likely to be linked with affective disorders - the biological or sociocultural reasons may be heterogenous. Our aim must be to identify this group at risk and offer hormonal, psychopharmacological, or psychotherapeutical support. We cannot rely on evidence-based recommendations for improving the quality of life in patients with gynecological malignoma by hormone replacement therapy. But we have evidence that adequate psychotherapeutic support has a positive effect on the individual woman s well-being.

The triage-function of a psychosomatic liaison-service for gynecological patients.

The psychosomatic psychotherapeutic consultation liaison (CL)-service for gynecological patients at the Vienna University has been evaluated. Research interest focused on success and failure of the initial interview, conceptualized for a specific clientele. The interview has a triage function for treatment planning. By the type of treatment that was applied, patients were divided into three groups: Group A, patients with one single contact with the unit; Group B, patients who were referred to external psychotherapy; Group C, patients who were treated with short-term psychoanalytic psychotherapy as offered by the service unit. The drop-outs figured as Group D. The questionnaires completed by the patients at the first consultation and 6 moths after their final contact with the clinic covered socio-demographic data, ego functions; the motivation for psychotherapy, a complaints list and finally, at the second contact only, an individual retrospective judgement concerning personal consequences of the consultation. Patients needs in CL-services call for quick decisions, which therapeutic measure would be most adequate. An experienced clinician's decision is based on several circumstances: individual feeling of suffering, therapy-motivation and ego-strength, as well as social and demographic facts. Comparing groups with different therapeutic recommendations showed that the psychometric tests discriminated well between these four groups and thus the validity of the clinical recommendation has been confirmed.

[Rudolf Ekstein's contributions to psychotherapy and child psychiatry]. / Rudolf Eksteins Beiträge zur Psychotherapie und Kinderpsychiatrie.

Rudolf Eksteins scientific career is closely linked to his personal history, with his Jewish heritage, his political involvement and his social work with young people, which guided him towards psychoanalytic educational theory. Following his forced emigration to the USA in 1938 he became a world-famous child therapist, psychoanalyst, scientist and professor of medical psychology at the Department of Psychiatry, UCLA. The most significant areas of Eksteins extensive scientific output are described in an attempt to do justice to his contributions to psychotherapy and child psychiatry. Eksteins introduction of a special technique for treating psychotic children with psychoanalytic psychotherapy was of major importance. His underlying concept of schizophrenic psychosis and borderline personality disorders in children is outlined. Further, we have tried to show in what way his contributions to psychoanalytic theory and techniques were influenced by his profound knowledge of philosophy and linguistics. Finally Eksteins dedications to the teaching and learning of psychotherapy is stressed, from which a whole generation of Austrian psychiatrists, psychologists and pedagogues have profited enormously, as a result of his long-standing teaching commitments as guest professor at Vienna University.

[Comments on the diagnostic principles of DSM-III exemplified by the borderline personality disorder]. / Uberlegungen zu den diagnostischen Prinzipien des DSM-III am Beispiel der Borderline-Persönlichkeitsstörung.

The first disputes around the DSM-III, which were charged with emotion and cathected by ideologies, are now followed by criticisms based on practical experience with the criteria used in the diagnostic approach of the DSM-III. The present paper is an attempt to show for the area of personality disorders, (and here in particular for borderline personality disorders) that the specific formulation of individual diagnostic questions is a contributory factor to the diagnostic assessment in this field, despite the descriptive approach of the DSM-III. By comparing different item formulations for the same criterion we try to illustrate the problems involved in a purely quantitative registration of characteristics. When criteria, such as identity, interhuman relationship, etc. are concerned, subjective variables will always contribute to the diagnostic assessment.

[The problem of delays of effective medical treatment in female patients with breast cancer]. / Zur Frage der Verzögerung effektiver medizinischer Behandlung bei Patientinnen mit Mammakarzinom.

In a study on psycho-social aspects of breast-cancer, information is presented on delays in the initiation of medical treatment. Two types of delay are distinguished: 1. Patient delay: i.e. the time elapsing between initial discovery of a lump in the breast by the patient herself and her seeking medical opinion; and 2. iatric delay: i.e. the time span between first presentation of the symptom by the patient to the doctor and onset of effective treatment. In order to obtain this information, semi-structured psychoanalytically oriented interviews, including rating scales for ego functions were carried out in a group of 32 patients with metastatic breast carcinoma. Patient delay is connected with the significance given to the symptom by the patient. This significance seems to depend on the degree to which the patient is informed, and on her body image, influenced by previous pregnancies and childbirth. Iatric delay is probably largely independent of these factors. Such delay cannot even be influenced by patients who take their symptoms seriously and request medical attention immediately. When trying to define a population at risk for breast cancer, the importance of denial is stressed as an additional factor.

[The psychosomatic-gynecological outpatients department of the II. Gynecological Clinic of the University of Vienna (author's transl)]. / Die psychosomatisch-gynäkologische Ambulanz an der II. Universitäts-Frauenklinik Wien.

A report is given on the organization and practice of an outpatients departments for psychosomatics in gynecology. The data of 284 patients concerning social status, possible trigger mechanisms (life events), diagnosis and treatment are presented. The applied therapeutic technique can be described as client centered counselling basing on psychoanalytic theory. the importance of cooperation between psychotherapist and gynecologist to the woman's benefit is emphasized.