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Intensive Crit Care Nurs ; : 102806, 2020 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-32037134


INTRODUCTION: Following intensive care treatment, patients and thier spouse often report traumatic memories that are frequently associated with post-traumatic stress symptoms. In this case report, we describe the case of a sepsis survivor and his wife who both suffered concurrently from intensive care associated post-traumatic stress symptoms as long-term sequelae. Both were treated with internet-based cognitive-behaviuoral writing therapy (iCBT) for post-traumatic stress disorder (PTSD) after intensive care. METHODS: Traumatic memories recalled during exposure in sensu as part of iCBT are described. Outcome data measured before, during and after psychotherapeutic treatment were analyzed. FINDINGS: Both, the patient and his wife showed characteristic symptoms of PTSD three years after discharge from the intensive care unit (ICU) comprising of intrusions, negative emotions, and hyperarousal. They reported unpleasant ICU memories from a patient's and relative's perspective, respectively. In both, the patient and his wife, a decline of symptoms with respect to all outcome measures during the course of iCBT from pre-treatment to three-month follow-up was observed. CONCLUSION: Experiences of critical illness and intensive care can lead to post-traumatic stress in patients and their partners. Hence, it may be useful to offer mental health screening and psychotherapeutic treatment options to both ICU patients and their partners.

Psychiatr Prax ; 46(8): 460-467, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31683336


OBJECTIVE: A pilot study was conducted to test a newly developed inventory for the assessment of malpractice in psychotherapy and its consequences. We aimed to examine the frequency of boundary crossings and violations in the context of psychotherapy from a patient's perspective and the resulting burden as well as to identify potential predictors. METHODS: Data assessment was realized in an online-based survey. The final sample existed of N  = 165 patients who underwent prior psychotherapeutic treatment. RESULTS: Patients reported M = 16.21 events which can be interpreted in terms of malpractice resulting in a mediocre level of distress. While malpractice summarized as "inadequate use of diagnostics/techniques" was reported most frequently, sexual boundary violations were associated with the highest levels of distress. CONCLUSION: The results demonstrate the need of a differential and systematic assessment of malpractice in psychotherapy. The new inventory especially seems to be suited for research purposes.

Mala Praxis , Relaciones Médico-Paciente , Psicoterapia , Alemania , Humanos , Mala Praxis/estadística & datos numéricos , Proyectos Piloto , Psicoterapia/legislación & jurisprudencia , Delitos Sexuales/legislación & jurisprudencia , Conducta Sexual
J Crit Care ; 53: 149-154, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31247513


PURPOSE: Aim of the present study was to compare the validity of three screening instruments to assess symptoms of posttraumatic stress disorder (PTSD) after intensive care of sepsis. MATERIAL AND METHODS: Participants were recruited within a large multicenter patient cohort study on long-term sequelae of sepsis. Adult patients (n = 83) on average four months after intensive care of (severe) sepsis or septic shock were included (median age 64 years, 60% male). PTSD symptom severity was assessed by three different self-report measures: two versions of the Posttraumatic Stress Scale (PTSS-10; PTSS-14), and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). A clinical PTSD diagnosis was derived by using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). RESULTS: Ten patients (12%) were diagnosed with PTSD. PTSS-10, PTSS-14, and PCL-5 revealed good reliability and concurrent validity. PTSS-14 showed the best accuracy in screening patients at risk for PTSD after intensive care with 80% sensitivity and 92% specificity at the recommended cutoff of 40. CONCLUSIONS: Compared to PTSS-10 and PCL-5, PTSS-14 appeared more appropriate for post-ICU PTSD screening when validated against a DSM-5 diagnostic interview.

BMJ Open ; 7(2): e014363, 2017 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-28232467


INTRODUCTION: As a consequence of sepsis and intensive care, considerable proportions of patients but also of their spouses develop a post-traumatic stress disorder (PTSD). However, only a very small number receive psychotherapeutic treatment. Internet-based cognitive-behavioural writing therapy (IB-CBWT) has proven to be an effective treatment option for PTSD. It seems to fit the specific needs of this cohort and to overcome treatment barriers. Aim of the REPAIR trial is to examine the efficacy, safety and applicability of IB-CBWT for PTSD in patients and their spouses after intensive care for sepsis. METHODS AND ANALYSIS: Participants will be assigned randomly either to a treatment or a wait-list (WL) control group. The treatment group receives IB-CBWT for PTSD, actively involving the partners of the participants. IB-CBWT will be guided by a therapist and comprises two written assignments per week over a 5 week period. After completing the assignments, the participants obtain individual responses from the therapist. Participants of the WL control group will receive treatment after a waiting period of 5 weeks. The primary outcome is PTSD symptom severity in self-rated PTSD Checklist for Diagnostic and Statistical Manual Fifth Edition at the end of treatment and waiting time, respectively. Secondary outcomes are remission of PTSD, depression, anxiety, and somatisation measured by the Brief Symptom Inventory-18, marital satisfaction measured by the Relationship Assessment Scale, health-related quality of life measured by the EQ-5D-5L, and the feasibility of IB-CBWT for this cohort (ie, dropout rate). Statistical analysis will be performed according to the intent-to-treat principle. ETHICS AND DISSEMINATION: The study is conducted according to the principles of Good Clinical Practice and has been approved by the ethics committee of the Friedrich-Schiller University Jena, Germany. Results will be disseminated at scientific conferences, published in peer-reviewed journals, and provided to consumers of healthcare. TRIAL REGISTRATION NUMBER: Pre-results, DRKS00010676.

Terapia Cognitivo-Conductual/métodos , Cuidados Críticos/psicología , Sepsis/psicología , Esposos/psicología , Trastornos por Estrés Postraumático/terapia , Escritura , Adulto , Femenino , Alemania , Humanos , Internet/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Calidad de Vida , Análisis de Regresión , Proyectos de Investigación , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Listas de Espera , Adulto Joven
J Affect Disord ; 205: 264-268, 2016 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-27472169


OBJECTIVE: The study represents a conceptual replication of the study by Eng et al. (2001) in a sample of adult patients diagnosed with social anxiety disorder as primary diagnosis. METHODS: Two different attachment questionnaires (Bielefeld Questionnaire of Client Expectations (BQCE) and Experiences in Close Relationships (ECR-RD)) were applied to examine whether the effect of attachment on depression (measured by the BDI) is mediated by social anxiety (measured by the LSAS) in a cross-sectional study. RESULTS: The data confirms such a mediation. The effect of attachment measured with the BQCE on depression was completely mediated, whereas the effect of both scales of the ECR-RD (attachment related avoidance and anxiety) on depression was only partially mediated by social anxiety disorder. CONCLUSION: The study supports the association of attachment, social anxiety, and depressive symptoms and the need to consider different perspectives on attachment.

Trastorno Depresivo/psicología , Apego a Objetos , Fobia Social/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Encuestas y Cuestionarios
Psychother Psychosom Med Psychol ; 63(1): 58-64, 2013 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-23341115


Based upon the concept of supportive-expressive therapy (SET), we developed a psychodynamic group treatment manual for social phobia, with a special focus on the patients' individual core conflictual relationship themes, their universality, as well as interventions promoting group processes and therapeutic factors of group therapy. We introduce the new concept and report results of a pilot case study (N=8). Analyses revealed a pre-post-treatment effect size of g=0.64 (95% CI [0.29; 1.00]) on the primary outcome measure, the Liebowitz Social Anxiety Scale (LSAS). Furthermore we obtained positive evidence with regard to acceptance, safety and feasibility of the psychodynamic group therapy concept for social phobia. Subsequent proof-of-concept studies are required to foster treatment development and to proof the replicability of results.

Trastornos Fóbicos/terapia , Psicoterapia de Grupo/métodos , Psicoterapia/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Trastornos Fóbicos/psicología , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Resultado del Tratamiento , Adulto Joven