[Students' attitudes towards psychotherapy: changes after a course on psychic functions in health and illness]. / Einstellungen von Medizinstudenten zu Psychotherapie: Veränderungen nach Unterricht über Psychische Funktionen in Gesundheit und Krankheit.

OBJECTIVES: Little is known about the attitude of medical students towards psychotherapy and the influence of lectures on psychotherapy during the medical curriculum on these attitudes. METHODS: 2 years in a row, medical students of the Medical University of Vienna in their fourth academic year were asked regarding their attitudes, connotations and associations towards psychotherapy before and after a 5-week psychotherapeutic course. RESULTS: The attitudes of the medical students were predominantly positive, while some prejudices could be found. The students' sex and prior experience with psychotherapy influenced their attitudes. The attitudes turned out to be relatively resistant to change through teaching. CONCLUSIONS: Reasons for the small influence of the training program on the students' attitudes and possible improvements of the course (small lecture groups) are discussed.

[The image of psychotherapies - a comparison between prospective therapists and laypersons]. / Das Bild der Psychotherapie(n) - ein Vergleich zwischen angehenden Psychotherapeuten und Laien.

OBJECTIVES: Considering the specific situation of psychotherapy in Austria with its wide range of different therapeutic methods which are accredited by law, we investigated their respective level of familiarity and the connotative associations of future therapists and of a sample group of the lay public regarding the different schools. METHODS: 175 persons (students of economics, students at the university clinic for psychoanalysis, and prospective psychotherapists) were interviewed concerning terms of familiarity and popularity of the therapeutic methods. Using the semantic differential we tried to operationalize the resonant connotative associations. RESULTS: There is insufficient information with regards to the existence of the various different schools on the side of the lay public. The connotations of the different groups are similar: independent of the level of familiarity, 4 different types of therapy can cluster-analytically be identified in relation to the 3 factors of the polarity profile (activity-potency-valence). CONCLUSIONS: More extensive information of the public concerning the different therapeutic possibilities is needed. Further the importance of considering subjective connotations in situations of referral and indication is discussed. Specific attention has been given to the situation of prospective psychotherapists.

Physical, sexual, and psychological violence in a gynaecological-psychosomatic outpatient sample: prevalence and implications for mental health.

OBJECTIVE: The main objective was to assess the prevalence of physical, sexual, or psychological violence in a cohort of patients with gynaecological symptoms who presented at a psychosomatic outpatient clinic. We assessed differences in prevalence rates of gynaecological symptoms and mental health problems in women with and without a history of experiencing violence. STUDY DESIGN: We performed a cohort study of women (n=424) who attended a psychosomatic-gynaecological outpatient clinic during a 6-year-period of time. Information about lifetime victimization, mental health status, and socio-demographic characteristics were systematically obtained through semi-structured interviews. Psychiatric diagnoses were made using questions adapted to the structured interview for DSM-IV. RESULTS: Some form of violence was reported by 39.9%. Of the total sample, physical violence was reported in 25.2%, sexual violence in 13.0%, and psychological violence in 23.8%. Of those with a history of experiencing violence, 26.1% experienced two different kinds of violence, and 14.8% were victims of all three kinds of violence. Perpetrators of physical and psychological violence were, predominantly, the partner or the father. With respect to sexual violence, perpetrators were exclusively male, including family members or friends in more than 80% of all cases. Women with a history of experiencing violence suffered significantly more often from major depressive disorders (29.6%) than those without a history of experiencing violence (16.5%) (p<.002). Post-traumatic stress disorder (PTSD) was significantly more frequent in women with a history of experiencing violence (7.1%) (p<.001). CONCLUSIONS: We found a high lifetime prevalence of different forms of violence toward women in our sample. Perpetrators were most often male family members, highlighting the impact of domestic violence. Our study provides evidence that women who attend a psychosomatic unit should be cautiously screened for a potential history of traumatic violent experiences.

[The Club of Female Professors of the Medical University Vienna]. / Der Professorinnenclub der Medizinischen Universität Wien : Eine Initiative zur Förderung von Frauen und Frauennetzwerken in den medizinischen Wissenschaften.

The Club of Female Professors of the Medical University Vienna (MUW) was founded in 2005 to strengthen and improve the impact of common concerns and ideas. The mission of this continuously growing club is to improve the situation of women, including colleagues, coworkers, students and patients, at the MUW. This important goal is pursued by continuous interaction with rectorate, academic senate and politicians.

[The capacity for mentalization in depressive patients: a pilot study]. / Mentalisierungsfähigkeit bei depressiven Patientinnen: Eine Pilotstudie.

OBJECTIVES: Mentalization has been primarily investigated in Borderline Personality Disorders. This pilot study takes the first step toward investigating mentalization in depressive patients. METHODS: First, we present the theoretical background of the concept of mentalization and previous studies. Secondly, we report the results of this pilot study. 20 female inpatients suffering from Major Depressive Disorder were investigated with SKIDI+II, depression-scales (HAM-D, BDI), cognitive tests (TMT, MCVCT), and the Adult Attachment Interview (AAI), rated according to the Reflective Functioning Scale (RF Scale). RESULTS: Depressed patients showed less capacity for mentalization (RF = 2.3) than did borderline patients (RF approximately 3) and healthy individuals (RF approximately 5). Comorbidity with dependent personality disorder correlated with higher RF scores, while comorbidity with schizoid personality disorder correlated with lower RF scores. CONCLUSIONS: Moderate to severe depression goes along with a breakdown of mental capacity. Further research should focus on investigating changes in the capacity for mentalization in remission and changes in the course of psychotherapeutic treatments.

[Treatment of depression: what do women need?]. / Depressionsbehandlung--was brauchen Frauen?

OBJECTIVES: To answer the question of adequate treatment of depression in women from a scientific point of view, it is necessary to investigate the aetiology of depressive disorders as they relate to bio-genetic, mental and social factors. METHODS: For a comprehensive understanding of depressive disorders in women three factors are analysed: (1) the severity of a depression, (2) the phenomenological description, and (3) the factors of the development of depression in the female life cycle. RESULTS: Different treatment strategies for women can be developed on the basis of these phenomenological and psychodynamic considerations. A case study of a female patient suffering from depressive adjustment disorder who had a background history of sexual reproductive problems is presented to demonstrate characteristic factors in women which may serve as indicators for psychoanalytic focal psychotherapy. DISCUSSION: In our opinion, psychoanalytic theory in its complexity, working with unconscious phantasies, fears concerning body integrity and relationships to others, is the most appropriate method to determine specific factors behind the pathogenesis and the persistence of depressive disorders in women.

Gender aspects in the planning of psychotherapy for borderline personality disorder.

OBJECTIVE: The aim of the study was to generate hypotheses for examining gender-specific variables with predictive value for the planning of successful psychotherapy in patients with borderline personality disorder. METHODS: Anxiety, aggression, interpersonal problems, locus of control and self-concept were investigated in twenty psychiatric inpatients before and after psychoanalytically oriented psychotherapy lasting for six weeks. RESULTS: Women in gender-matched patient-therapist dyads gained insight into relationships between anxiety, aggression and interpersonal problems to the extent that they experienced them as ego-syntonic problems and as a concern of their own self-concept, and were therefore able to engage in further outpatient psychotherapy. Men more often remained in regressive resistance and in narcissistically boosted conviction of self-efficacy, with simultaneous persistence of aggression and non-engagement in further psychotherapy. CONCLUSION: The results underline the importance of considering gender role stereotypes and suggest the significance of gender-sensitive attitudes in dealing with aggression and exploring attachment styles and reflective functioning.

Austrian medical students' attitudes towards male and female homosexuality: a comparative survey.

BACKGROUND: The attitudes of health-care professionals and medical students towards male and female homosexuality are of practical relevance and have increasingly become a topic of scientific research. Comparative investigations between medical students and other student groups have not yet been conducted. OBJECTIVES: To assess the attitudes of Austrian medical students towards homosexuality and to compare these with the attitudes of students of politics and veterinary medicine. METHODS: Students of medicine (122), politics (145), and veterinary medicine (153) completed a questionnaire consisting of validated instruments assessing anti-homosexual attitudes, items assessing knowledge on homosexual issues, and basic demographic information. RESULTS: Participants' attitudes were predominantly positive. For all instruments, two-way analyses of covariance revealed significant influences of participants' sex and study major: students of medicine and veterinary medicine held more negative attitudes than students of politics, and males were more prejudiced than females. Overall, attitudes towards male and female homosexuality were balanced, but male students of politics and veterinary medicine were more prejudiced towards male than female homosexuality. A significant influence of participants' sex (favoring females) was observed in knowledge of homosexual issues. CONCLUSIONS: Although neutrality and empathy are considered vital in the doctor-patient relationship, medical students revealed more negative attitudes than students of politics did, the latter's attitudes being similar to those of students of veterinary medicine. These findings suggest that educational and correcting interventions are required in medical training.

[Indikationsfragen zur psychotherapie bei psychosomatischen patientinnen.].

The diagnostic process of psychosomatic patients finally arriving at an indication for psychotherapy is an important point of reference in the present discussion concerning the introduction of special clinics for psychosomatic patients in Austria: equippment of such clinics and standards for the personnel has to relate to the needs of these patients. The Etiology of psychosomatic disturbances includes psychological influences, which, via psychoneuroendocrinolgical mechanisms interact with somatic factors, and individual coping styles, shaped by the social environment and gender-related factors. The initial interview, besides physical complaints, has to assess the patient's reality sense, the affective competence, the cognitive competence, the nature and quality of relations with important others, the subjective illness-theories and the motivation for psychotherapy. The therapeutic method/setting finally choosen has to offer a scientifically based concept of psychosomatic disturbances, according to the different operationalisations of Psychosomatic.

[Relationship between psychosomatic medicine and psychotherapy in theory and practice]. / Zum Verhältnis von Psychosomatik und Psychotherapie in Theorie und Praxis.

Initially, the different operationalizations of 'psychosomatic' are presented. Etiological concepts of psychosomatic illness include stressful life events, developmental factors and the individual psychic structure. At the Department for Psychotherapy and Psychoanalysis of Vienna University, the initial diagnostic interview includes subjective illness theories as possible pathway to psychotherapy, motivational factors and the patient's ability to transfer the experience from this interview into psychotherapy proper. The psychotherapeutic method applied to psychosomatic patients should offer a theoretical concept concerning psychosomatic illness, as it is the case in psychoanalytic psychotherapy. Finally, the importance of supervision for psychotherapists working in an institutional setting with in-patients is stressed.

Can legislation provide a better match between demand and supply in psychotherapy?

BACKGROUND: There is evidence showing that psychotherapy very often does not reach the persons most in need of it. A change in patterns of "consumer behaviour" is difficult to achieve on the basis of individual behavioural change. Can it be achieved by changes in legislation? METHODS: By comparing socio-demographic criteria of patients seen at the University Clinic of Psychoanalysis and Psychotherapy between 1990 and 1996, we are able to give some evidence that changes in legislation, concerning psychotherapy, which took place in the years 1991, 1994 and 1995, had a significant effect on the socio-demographic composition of our patient population, showing a convergence of patient population towards the socio-demographic criteria of the population of Vienna. CONCLUSION: We argue that the changes in legislation in Austria, concerning funding of psychotherapy, and introducing a new profession "psychotherapist", have a measurable effect which works in two ways: 1) direct effect: decreased financial charge of patients; 2) indirect effect: increased motivation of patients, resulting from a reduction in stigmas attached to the role of "psychiatric patient".