Improving adherence to immunosuppression after liver or kidney transplantation in individuals with impairments in personality functioning - A randomized controlled single center feasibility study.

Introduction: Although adherence to immunosuppressive medication is the key factor for long-term graft survival today, 20-70% of transplant recipients are non-adherent to their immunosuppressive medication. Objective: A prospective, randomized, controlled single-center feasibility study was designed to evaluate the impact of a step guided multicomponent interprofessional intervention program for patients after kidney or liver transplantation on adherence to their immunosuppressive medication in daily clinical practice. Materials and methods: The intervention consisted of group therapy and daily training as well as individual sessions in a step guided approach. The primary endpoint of the study was adherence to immunosuppression as assessed with the "Basel Assessment of Adherence to Immunosuppressive Medications Scale" (BAASIS). The coefficient of variation (CV%) of Tacrolimus (TAC) through levels and the level of personality functioning was a secondary endpoint. We conducted six monthly follow-up visits. Results: Forty-one age- and sex-matched patients [19 females, 58.5 (SD = 10.56) years old, 22 kidney- and 19 liver transplantation] were randomized to the intervention- (N = 21) or control-group (N = 20). No differences between intervention- and control groups were found in the primary endpoint adherence and CV% of TAC. However, in further exploratory analyses, we observed that individuals with higher impairments in personality functioning showed higher CV% of TAC in the controls. The intervention might compensate personality-related susceptibility to poor adherence as evident in CV% of TAC. Discussion: The results of the feasibility study showed that this intervention program was highly accepted in the clinical setting. The Intervention group could compensate higher CV% of TAC after liver or kidney transplantation in individuals with lower levels of personality functioning and non-adherence. Clinical trial registration: ClinicalTrials.gov, identifier NCT04207125.

Factors associated with and risk factors for depression in cancer patients - A systematic literature review.

OBJECTIVE: The prevalence of depression in oncological patients is 3, 4-fold compared to the general population. However, the specific risk factors for these prevalence rates are not fully understood. METHODS: A systematic literature review was conducted in nine electronic databases between 2005 and 2020. The quality of the eligible studies was appraised by two persons using the adapted 11-items Downs and Black checklist. RESULTS: Among 2010 potentially relevant articles, 40 studies were eligible, with 27 studies of high quality and 13 studies of moderate quality. A total of 156 factors associated with depression were identified which were clustered into somatic, psychological, social and sociodemographic factors. Pre-existing depression and personality factors were the most consistent associated factors with depression in cancer patients, while for most somatic and treatment-related factors only modest associations were found. CONCLUSIONS: Grouped as bio-psycho-social associated factors, somatic factors showed a modest influence, whereas social relationship (support) and previous depression are unequivocally significantly associated with depression.

Communicative and social competence in the medical curriculum of the Medical University of Innsbruck: learning objectives, content, and teaching methods.

Aim: The Austrian Competence Level Catalogue for Medical Skills clearly states the importance of teaching communicative and social competence in the different subject areas of undergraduate medical and dental education. This paper aims to present an overview of the academic courses at the Medical University of Innsbruck that explicitly address the promotion of communication and social skills in medical students. Method: This paper focuses on educators' descriptions of how communicating with patients is taught. The Medical University's longitudinal curriculum on medical interviewing is presented in detail. The courses on ethical principles in the dissection course, palliative medicine, and gender medicine are also outlined as examples. In addition, lecturers (n=536) participated in an online survey to determine the teaching and testing content regarding patient communication and to measure the value attached to the associated teaching and learning methods. Results: The examples given by educators to illustrate learning objectives, educational content, and the teaching methods used to impart communicative and social competence provide an overview of the courses which focus on this topic or intentionally address it during the course. The results of the online survey offer a broad overview of the awareness of the topic at the university. Different testing formats are used to assess the skills being taught. Conclusion: Familiarity with the various teaching methods used in the different courses is important for developing communicative and social competence in medical education. Active networking is necessary to anchor communicative and social competency as a major thread throughout an entire medical curriculum.

[Psychosocial factors in reproductive medicine]. / Psychosoziale Aspekte in der Fortpflanzungsmedizin.

INTRODUCTION: Since the development of assisted reproduction technology in the 1970s, assisted reproduction has become increasingly used by couples for various reasons. Concurrently, the diagnostic possibilities regarding the health of the unborn child have been elaborated. METHODS/RESULTS: The present literature review describes and discusses the possibilities of assisted reproduction (in-vitro fertilization (IVF), intracytoplasmic sperm injection ICSI, cryopreservation, conception of children with the help of a third person) with respect to their psychosocial meaning for those affected and for the children conceived in this manner. The psychological strain pairs experience in the context of prenatal diagnostics and the resulting decisions are illustrated by a case study. CONCLUSIONS: The continued progression in the possibilities and resulting conflicts and decision- making processes in reproductive medicine confronts clinicians and psychosomatic/psychotherapeutic practitioners with many new challenges. In conclusion clinical recommendations for the psychosocial counseling of couples are given.

[Narcissism self-expression - the generation me?]. / Narzisstische Selbstdarstellung - Generation Me?

OBJECTIVES: A self-report questionnaire to assess conflict was created from the conflict axis of the Operationalized Psychodynamic Diagnostics (Arbeitskreis OPD-2 2006; Arbeitskreis OPD-KJ-2 2013). METHODS: In a paper-pencil test we compared a sample of 501 assumed healthy teenagers of between 12 and 17 years, a sample of 31 adolescent psychosomatic inpatients, and a sample of 20 adolescents psychiatric inpatients. RESULTS: We found significant sex and age differences concerning narcissistic self-expression. Significant differences between the three groups as well as significant correlations with common clinical instruments (BSI,IPO, IIP) revealed narcissistic self-expression to be problematic. DISCUSSION: The questionnaire demonstrated a high level of reliability.Narcissistic self-expression is higher in the healthy control group, for male adolescents and older adolescents. There is, however, a significant correlation with psychological symptoms and interpersonal problems.

How addiction develops and what are the consequences - a psychodynamic approach. Addiction and psychodynamic aspects.

BACKGROUND: The reward-system can be differentiated from the motivational system. METHODS AND RESULTS: A complex psychodynamic approach (OPD-2) takes into account motivational aspects - psychological functioning - the drug and the consequences. Multiaxial aspects are necessary. The system is described. CONCLUSIONS: A psychodynamic cycle of addiction enables different therapy steps.

Long-term course in female survivors of childhood abuse after psychodynamically oriented, trauma-specific inpatient treatment: a naturalistic two-year follow-up.

OBJECTIVES: This study examined the long-term course of 43 female survivors of childhood abuse after receiving inpatient treatment based on psychodynamic-orientated trauma therapy. METHODS: Data on symptom load was assessed at admission, discharge and two-year follow-up. Further information on post-discharge treatment and life events in the follow-up period was collected. RESULTS: At two-year follow-up global symptom load (GSI), PTSD, depression (d = 0.43-0.57) and self-soothing ability (d = 0.72) were significantly improved compared to the admission status with no change in dissociative symptoms. 40% of the sample showed good long-term outcome (clinical significant change, GSI) with a significant reduction in depressive, dissociative and by trend in PTSD symptoms. There were no group differences in the amount of stressful life-events and treatment in the follow-up period. Patients with good outcome showed more previous inpatient treatment. CONCLUSIONS: Inpatient treatment leads to a significant symptom reduction in women with severe childhood abuse. The treatment effects remain stable for two years under further outpatient psychotherapy.

[Patterns of dysfunctional parenting styles and psychological disturbances in offspring]. / Muster dysfunktionaler Erziehungsstile und psychische Storungen im Erwachsenenalter.

OBJECTIVES: Dysfunctional parenting styles represent a risk factor for the development of psychological disturbances. The present study investigated the differential validity of the German language Fragebogen zur Erfassung dysfunktionaler Erziehungsstile (FDEB; Measurement of Parental Styles, MOPS) and determined whether different forms of psychological disorders are associated with specific patterns of parenting styles. METHODS: 145 inpatients, 108 outpatients and a control group of 633 representative individuals from the general population were investigated by adapting the FDEB. RESULTS: A comparison of dysfunctional parenting styles showed different distress levels within the diagnostic groups: Patients suffering from depression reported high levels of maternal indifference and over protectiveness together with an abusive rearing behavior on the part of both parents. Patients with anxiety disorders reported having overprotective mothers. Bulimic patients as well as those with personality disorders significantly exhibited stress in almost all areas. However, anorexic patients did not differ significantly from the control group, which appeared to be the least affected of all. CONCLUSION: The FDEB showed a satisfactory differential validity. There was evidence that specific patterns of dysfunctional parenting styles were associated with different diagnostic groups.

The first step is the hardest - emotion recognition in patients with somatoform disorders.

OBJECTIVES: The aetiology of somatoform disorders is assumed to consist of several factors, as alexithymia, dysfunctional cognitions and emotion regulation. As a consequence of somatoform disorders social withdrawal is discussed. Several studies prove connections between mental problems, emotion recognition, and functioning social relationships. METHODS: A sample of 35 patients suffering from a somatoform disorder and a sample of 73 persons without any somatoform symptoms were investigated according to their ability to identify emotional facial expressions (computer-assisted presentation of photos). RESULTS: Our results demonstrate significant differences in the ability to decode others' emotional states between people with or without somatoform disorders. In all six tests the patients achieved significantly worse results. CONCLUSIONS: Our results suggest that psychotherapeutic treatment of patients with somatoform disorders should also focus on the recognition of emotions and deal with them.

[Depressives have the better view - the influence of mood on the recognition of emotional expression]. / Depressive sehen besser-der Einfluss der Stimmung auf das Erkennen emotionaler Gesichter.

OBJECTIVES: There are different approaches to whether depressed people perceive their environment differently than nondepressed.We analyzed whether depressed patients show greater deficits in decoding emotional expressions than nondepressives. METHODS: A sample of 52 depressed patients and a sample of 72 nondepressed persons were investigated as to their ability to identify emotionally laden facial expressions (computer-assisted presentation of photos). RESULTS: Our results demonstrate significant differences between depressive patients and nondepressive persons in the ability to decode the emotional states of others. In four out of six tests the depressive persons achieved significantly better results. CONCLUSIONS: We suggest that these results can be interpreted as further evidence for the concept of depressive emotional realism.

[The neuropsychological principles of psychotherapy]. / Neuropsychologische Grundlagen der Psychotherapie.

Recent advances achieved in the field of clinical neuro(bio-)psychology have been varied and impressive. Together with the related social and psychosocial aspects, they contribute to and enrich the development of new options in diagnosis and psychotherapy. Important research results are discussed here based on the examples of depression, Alzheimer's disease and self-injury, which profit greatly from neuropsychological research, especially through early detection of symptoms and prevention.

[Officer in charge, that unknown being - an explorative, qualitative study of unconscious fears, wishes, and defense mechanisms]. / Das Unbekannte Wesen Einsatzleiter - Eine Explorative Qualitative Studies zur Erfassung Unbewusster Ängste, Wünsche und Abwehrmechanismen.

OBJECTIVES: The stress and coping strategies found among emergency relief personnel have been studied in detail but without considering their function in the team. However, specifically officers in charge have to be addressed and investigated separately. This study focuses on the unconscious desires, fears, and defense mechanisms present in order to improve our understanding of the stress experienced during operations. METHODS: Four officers in charge were interviewed concerning their stressful experiences during operations. These interviews were then coded and analysed using the JAKOB Narrative Analysis ("Klinische Erzählanalyse JAKOB", Boothe et al. 2002). RESULTS: The recorded unconscious desires included solidarity, phallic integrity, generativity, unconscious fears destruction, loss of power/influence, and social hostility, and as defense strategies rationalism, repression/denial, and idealization. CONCLUSIONS: The analysis of the interviews shows a high reliability between the raters (0.74-0.79). The greatest burden for officers in charge is a loss of safety. Especially being confronted with strains in their own team leads to stress, which shows that the methods used for stress management following critical incidents is not sufficient.

[Preoperative evaluation of the body concept of donors and recipients of living kidney donations]. / Präoperative Evaluation des Körperkonzepts von Nierenlebendspendern und -empfängern.

OBJECTIVES: The psychosocial evaluation of the body concept of living kidney donors and recipients is part of a general psychosocial assessment as well as the early detection of organ integration disorders. METHODS: From 2010 to 2011 we investigated the eligibility for living kidney donation in 36 living kidney donors and 36 recipients using a semistructured clinical interview and the German version of the Transplant Evaluation Rating Scale (TERS). In addition, we used the Fragebogen zum Körperbild (FKB-20) to evaluate body concept. RESULTS: Living kidney donors and recipients differed in their body concept. Living kidney recipients described a body-centered disturbance stemming from a reduction of body-intensive activities including destabilization of body concept. CONCLUSION: The psychological coping process involved in living kidney donation demands a reconstitution of the body self. The coping/health behavior and the affective state of living kidney recipients are protective factors that influence successful organ integration.

[ADHD across the lifespan - an update on research and practice]. / ADHA über die lebensspanne - ein update aus forschung und praxis.

ADHD can be regarded as a lifespan disorder. From biopsychosocial vantage point, ADHD leads to age-specific impairments, high psychological distress and is associated with a high occurrence of comorbid disorders. For this review, we summarize actual findings from epidemiological, neuroscientific and clinical studies to present an overview of ADHD-research. We discuss the proposed revisions for DSM-V criteria by comparing them with the present DSM-IV-TR criteria, with a focus on the implications for research and practice. In the second part of this paper, we present new findings from socioeconomic, diagnostic and therapeutic perspectives. There is evidence for a high economic burden that is indirectly caused by ADHD (e.g., production loss, material costs, higher accident rates). Consequently, there is a high demand for comprehensive diagnostic and therapeutic approaches. We present a summary of the latest available diagnostic instruments and therapeutic manuals. The results of research and practice show a growing support for a lifespan perspective on ADHD psychopathology. The burdens resulting from ADHD are evident in all age groups, which has led to establishing age-specific diagnostic and therapeutic materials. Although there is a lack in ADHD-specific healthcare in adulthood, this should be realized by structural changes in healthcare services.

Results of a psychosomatic training program in China, Vietnam and Laos: successful cross-cultural transfer of a postgraduate training program for medical doctors.

BACKGROUND: With the "ASIA-LINK" program, the European Community has supported the development and implementation of a curriculum of postgraduate psychosomatic training for medical doctors in China, Vietnam and Laos. Currently, these three countries are undergoing great social, economic and cultural changes. The associated psychosocial stress has led to increases in psychological and psychosomatic problems, as well as disorders for which no adequate medical or psychological care is available, even in cities. Health care in these three countries is characterized by the coexistence of Western medicine and traditional medicine. Psychological and psychosomatic disorders and problems are insufficiently recognized and treated, and there is a need for biopsychosocially orientated medical care. Little is known about the transferability of Western-oriented psychosomatic training programs in the Southeast Asian cultural context. METHODS: The curriculum was developed and implemented in three steps: 1) an experimental phase to build a future teacher group; 2) a joint training program for future teachers and German teachers; and 3) training by Asian trainers that was supervised by German teachers. The didactic elements included live patient interviews, lectures, communication skills training and Balint groups. The training was evaluated using questionnaires for the participants and interviews of the German teachers and the future teachers. RESULTS: Regional training centers were formed in China (Shanghai), Vietnam (Ho Chi Minh City and Hue) and Laos (Vientiane). A total of 200 physicians completed the training, and 30 physicians acquired the status of future teacher. The acceptance of the training was high, and feelings of competence increased during the courses. The interactive training methods were greatly appreciated, with the skills training and self-experience ranked as the most important topics. Adaptations to the cultural background of the participants were necessary for the topics of "breaking bad news," the handling of negative emotions, discontinuities in participation, the hierarchical doctor-patient relationship, culture-specific syndromes and language barriers. In addition to practical skills for daily clinical practice, the participants wanted to learn more about didactic teaching methods. Half a year after the completion of the training program, the participants stated that the program had a great impact on their daily medical practice. CONCLUSIONS: The training in psychosomatic medicine for postgraduate medical doctors resulted in a positive response and is an important step in addressing the barriers in providing psychosomatic primary care. The transferability of western concepts should be tested locally, and adaptations should be undertaken where necessary. The revised curriculum forms the basis of training in psychosomatic medicine and psychotherapy for medical students and postgraduate doctors in China, Vietnam and Laos.