Dysfunctional self-reported interoception predicts residual symptom burden of fatigue in major depressive disorder: an observational study.

BACKGROUND: Fatigue is a core symptom of major depressive disorder (MDD) and is frequently refractory to antidepressant treatment, leading to unfavorable clinical/psychosocial outcomes. Dysfunctional self-reported interoception (i.e., maladaptive focus on the body's physiological condition) is prevalent in MDD and could contribute to residual symptom burden of fatigue. Therefore, we explored (a.) cross-sectional correlations between both dimensions and investigated (b.) prospective associations between interoceptive impairments at admission and symptom severity of fatigue at the end of hospitalization. METHODS: This observational, exploratory study included 87 patients suffering from MDD who completed self-rating scales, the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), and the Multidimensional Fatigue Inventory (MFI-20), at the beginning and end of hospitalization. Bivariate correlations (r) and hierarchical regression analyses were performed. RESULTS: The cross-sectional analysis showed moderate to large negative correlations between the MAIA-2 and MFI-20 dimensions except for the Not-Distracting scale. Symptoms of general, physical, and mental fatigue at the end of hospitalization were predicted by reduced body Trusting (ß = -.31, p = .01; ß = -.28, p = .02; ß = -.31, p = .00, respectively). Increased Body Listening (ß = .37, p = .00), Not-Worrying (ß = .26, p = .02), and diminished Attention Regulation (ß = -.32, p = .01) predicted higher mental fatigue. CONCLUSIONS: Diminished body confidence at baseline identified patients at risk for post-treatment fatigue and could therefore serve as a target for improving antidepressant therapy. Body-centered, integrative approaches could address treatment-resistant fatigue in MDD. However, clinicians may also consider the potential adverse effect of increased Body Listening and Not-Worrying on mental fatigue in psychotherapeutic and counselling approaches. Due to the exploratory nature of this study, the results are preliminary and need to be replicated in pre-registered trials with larger sample sizes.

Exploring Associations between C-Reactive Protein and Self-Reported Interoception in Major Depressive Disorder: A Bayesian Analysis.

Major depressive disorder (MDD) is associated with dysfunctional self-reported interoception (i.e., abnormal perception of the body's physiological state) and systemic inflammation, both of which adversely affect treatment response. In this study, we explored associations between C-reactive protein (CRP) and self-reported interoception, to gain more insight into the pathophysiology of interoceptive impairments in MDD. We also aimed to replicate previous findings on the associations of depression and fatigue severity with CRP. The study included 97 depressed individuals, who completed self-administered questionnaires (Multidimensional Assessment of Interoceptive Awareness (MAIA-2); Beck Depression Inventory-II, Multidimensional Fatigue Inventory). CRP concentrations were analyzed in the serum using a particle-enhanced turbidimetric immunoassay. We applied Bayesian inference to estimate robust effect parameters from posterior distributions based on MCMC sampling, and computed Bayes factors (BF10) as indices of relative evidence. The bivariate analysis supported evidence against associations between CRP and self-reported interoception (BF10 ≤ 0.32), except for one dimension (Not-Distracting: r = 0.11, BF10 > 0.43, absence of evidence). Positive correlations with overall depression (r = 0.21, BF10 = 3.19), physical fatigue (r = 0.28, BF10 = 20.64), and reduced activity (r = 0.22, BF10 = 4.67) were found. The multivariate analysis showed moderate evidence that low-grade inflammation predicted higher scores on the MAIA-2 Not-Worrying scale (ß = 0.28, BF10 = 3.97), after controlling for relevant confounders. Inflammatory responses, as measured by CRP, may not be involved in the pathophysiology of dysfunctional self-reported interoception. However, systemic low-grade inflammation could potentially exert a protective effect against worries about pain or discomfort sensations. An immunological involvement in interoceptive impairments cannot be ruled out until future studies considering additional biomarkers of inflammation replicate our findings.

Differences in life attitudes between general population and hospitalized psychosomatic patients: a comparative cross-sectional study.

To compare the extent to which value-based life attitudes measured by means of the Life Attitude Profile (LAP-R) could differ between the general population and people suffering from mental disorders hospitalized in a psychosomatic ward. Cross-sectional comparative study between a sample of general population (n = 409) and a sample of unselected patients (n = 147) at admission in a psychosomatic ward. Comparisons were carried out by means of Cronbach's alpha, correlation matrix, t-tests, robust multivariate linear regression models (MLRM), and using propensity scores. The internal consistency of LAP-R is good (alpha = 0.90). Divergent validity with BFI dimensions is widely given. In MLRM general population scored higher for the indexes 'personal meaning' and 'existential transcendence', whereas psychosomatic patients for the dimensions 'responsibleness', 'death acceptance', 'goal seeking' and especially 'existential vacuum'. Sex, partnership and schooling display few associations. Neuroticism is negatively and agreeableness positively associated with life attitudes considered as protective. Norm values and differences were stratified by age ranges. This study demonstrates that basic human attitudes like personal transcendence, personal meaning, having a biographically supported mission in life, and belief in a reason for existence are so fundamental for individuals that they are to some degree given independently of having a mental disorder or not. Neuroticism is a risk trait and agreeableness a protective trait facing life attitudes. The findings of this study indicate that people suffering from mental disorders treated in a specialized psychosomatic unit in a general hospital have important value-based resources and simultaneously higher levels of existential vacuum that have to be considered in treatment planning but should also be embedded in a therapeutic alliance. The existential vacuum deserves special consideration in the treatment of patients, especially facing risk of suicide.

Psychological changes after coronary angiographic intervention: pre-post comparison and follow-up.

Epidemiological studies demonstrate the relevance of cardiovascular diseases for health policies and medical care, especially coronary heart diseases and myocardial infarction. Research has shown that a significant proportion of patients undergoing coronary angiography suffer from clinically relevant mental stress. The aim of this study is to investigate to what extent the psychological state of cardiology patients changes in short- and mid-term periods after coronary angiography has been performed. The study design is naturalistic, longitudinal and comparative about consecutively admitted patients undergoing coronary angiography (N = 419; consenting patients fulfilling inclusion criteria n = 68) at four measurement points: before and after angiography and 6 weeks and 6 months after discharge. The statistical analysis includes paired t-tests, chi-square tests, effect sizes and random effects regression models. The sample was representative of the target population. The prevalence of risk factors were: 84% heart attack, 31% diabetes and 84% hypertension. There were no angiographic pathological findings in 12% of the sample. The neuroticism levels of the sample was higher than in the general population. There were almost no pre-post differences for depression, anxiety, psychological well-being, self-efficacy, resilience or locus of control. At the mid-term, well-being and anxiety decreased and internal locus of control increased. Neuroticism was negatively and extraversion and openness were positively associated with mental state and resources. The sample showed persistent adverse subsyndromal depressivity. At the mid-term, patients realised that their prognosis also depends on their own behaviour (internal attribution). Special psychosomatic attention should be given to people with subsyndromal depression, higher emotional instability and those with angina pectoris symptoms displaying normal coronary angiography.

The relationship between dental anxiety and other kinds of anxiety: a naturalistic, cross-sectional and comparative study.

BACKGROUND: Dental anxiety is of public health importance because it leads to postponed dental treatment, which comes with health complications. The present study investigated whether there is a correlation between the degree of dental anxiety and other kinds of anxiety and whether there are prognostic factors for the different kinds of anxiety. METHOD: In the sample (N = 156) from a dental practice in a large German city, 62% of patients received a check-examination and 38% received dental surgery. The target variables were recorded with validated questionnaires: dental anxiety (IDAF-4c+), subclinical anxiety (SubA), anxiety of negative evaluation (SANB-5), current general anxiety (STAI state), loneliness (LS-S) and self-efficacy (GSW-6). The applied statistics were: t-tests for 31 variables, correlation matrix and multivariate and bivariate regression analyses. RESULTS: The dental surgery patients displayed more dental anxiety and more dental interventions than the check-examination group. The main result was a positive correlation of all kinds of anxiety with each other, a positive correlation of loneliness and neuroticism with all forms of anxiety and a negative correlation between all forms of anxiety and self-efficacy. Especially dental anxiety is positively associated with other kinds of anxiety. In multivariate regression models only neuroticism is associated with dental anxiety, but feelings of loneliness are positively associated with with the other kinds of anxiety assessed in this study. The higher the self-efficacy, the lower the level of general anxiety. CONCLUSIONS: In dentistry, anxiety from negative experiences with buccal interventions should be distinguished from anxiety caused by personality traits. Self-efficacy tends to protect against anxiety, while loneliness and neuroticism are direct or indirect risk factors for anxiety in this urban dentistry sample. Dental anxiety seems to be independent from biographical strains but not from neuroticism. In practice, more attention must be paid to anxiety control, self-management and efforts to improve the confidence of patients with emotional lability, less self-confidence and propensity to shame.

Divergent patterns of confrontation with death using the Anticipated Farewell to Existence Questionnaire (AFEQT): a cross-sectional comparative study of four samples with increasing proximity to death.

BACKGROUND: Based on the concept of "Daseinsverabschiedung", an anthropological theory of "Anticipated Farewell to Existence" (AFE) was suggested on the basis of six grounding dimensions: selfhood, interpersonality, temporality, corporeality, worldliness, and transcendence, which are activated in a genuine manner facing death. The purpose of the study is to quantitatively compare the extent of confrontation with death between dying people in palliative care and those in other stages of life by means of the Anticipated Farewell to Existence Questionnaire" (AFEQT), based on these dimensions. METHODS: The sample (N = 485) consists of dying individuals in palliative wards and hospices (n = 121); old people living in nursing homes not suffering from a mortal disease (n = 62); young adults (n = 152), and middle-aged adults (n = 150). The design is cross-sectional and analytical. The relevance of anticipated farewell to existence was measured by means of the AFEQT. The internal consistency of the AFEQT was assessed using Cronbach's alpha and convergent validity by means of dimensions of the Life Attitude Profile-Revised (LAP-R). Differences between groups and associations with control variables were estimated by means of multiple regression models, including propensity scores. RESULTS: Cronbach's alpha for AFEQT was > 0.80 for the whole test and all subsamples, but < 0.70 for most dimensions in dying people. Correlations between each dimension and corresponding two factors was almost overall r > 0.80, p < 0.001. Good convergent validity between dimensions of AFEQT and of Life Attitude Profile-Revised in young and middle-aged participants showed correlations for superordinate indices between -0.23 and 0.72, and an overall p < 0.001. Dying people scored significantly higher for all dimensions, especially "altruistic preoccupation" and "reconciliation with existence" than people in other life stages (p < 0.01- < 0.001). Personality traits of "openness" and "agreeableness" are positively associated with higher scoring of AFEQT dimensions. About 77% of dying participants reported a personal benefit through the interview questions. CONCLUSIONS: With proximity to death, the anthropological dimensions proposed scored significant higher than in other stages of life, reflecting a stronger awareness, confrontation and reconciliation with the end of their own life. These dimensions, especially preoccupation for related persons and coexistence of acceptance and struggle with death have to be taken into account in a sensitive way by supporting dialogues with dying people and their relatives. TRIAL REGISTRATION: Observational cross-sectional study.

Validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire in hospitalized patients with major depressive disorder.

OBJECTIVES: Interoception refers to the sensation, interpretation, and integration of internal somatic signals. Abnormalities in self-reported interoception are prevalent features of major depressive disorder (MDD) and may affect treatment outcomes. In the present study, we investigated the psychometric properties of the revised eight-dimensional and 37-item Multidimensional Assessment of Interoceptive Awareness questionnaire (the MAIA-2) in a severely depressed sample, after translating two updated scales (Not-Distracting, Not-Worrying) into German. Specifically, we examined the measure's internal consistency reliability, sensitivity to change, and minimal important differences (MID) with a focus on patient's antidepressive responses to treatment. METHODS: The study enrolled 110 participants (age: M = 46.85, SD = 11.23; female: 55.45%) undergoing hospital treatment, of whom 87 were included in the pre-post analysis. Participants completed a German translation of MAIA-2 and the Beck Depression Inventory-II (pre-/post-treatment). Internal consistency reliability was determined by Cronbach's α/McDonalds's ω, sensitivity to change was determined by effect sizes, and MIDs were determined by distribution- (0.5*SD) and anchor-based approaches (mean change method; ROC curve cut-points). RESULTS: Depression severity reduced over the course of treatment (Median = -65.22%), and 34.48% of patients achieved remission. Reliability was appropriate for post-treatment (range of ω: .70-.90), but questionable for two pre-treatment scales (Noticing: ω = .64; Not-Distracting: ω = .66). The eight dimensions of MAIA-2 were sensitive to change (standardized response mean: .32-.81; Cohen's effect size: .30-.92). Distribution-based MIDs (.38-.61) and anchor-based mean change MIDs (remission vs. partial response: .00-.85; partial response vs. nonresponse: .08-.88) were established on the group level. For six scales, ROC cut-points (remission: .00-1.33; response: -.20-1.00) demonstrated accurate classification to treatment response groups on the individual level. CONCLUSIONS: This study demonstrated the applicability of the MAIA-2 questionnaire in MDD. The updated version may have led to reliability improvements regarding the revised scales, but subthreshold reliability was evident prior to treatment. The measure's dimensions were sensitive to change. MIDs were established that corresponded with antidepressive treatment outcomes. Our findings are consistent with a growing area of research which considers somatic feelings as key contributors to mental health.

Can changes in multidimensional self-reported interoception be considered as outcome predictors in severely depressed patients? A moderation and mediation analysis.

OBJECTIVE: Somatic complaints (e.g. pain) and abnormal self-reported interoception (e.g. maladaptive bodily self-focus) are common features of major depressive disorder (MDD) with sex-specific manifestations. Whereas somatic symptoms are associated with adverse clinical outcomes (e.g. residual symptoms), studies are scarce investigating the role of interoception as an outcome predictor for specific hospital treatment of MDD. Therefore, multivariate associations between changes in multidimensional self-reported interoception, somatic symptoms, and clinical improvements are explored by hypothesizing interactions with sex and an interoceptive mechanism. METHODS: In this naturalistic study, 87 hospitalized participants suffering from MDD completed questionnaires at pre- and post-treatment assessing multidimensional self-reported interoception (MAIA-2), somatic symptom burden (SCL-90-S® SOMA), and depression severity (BDI-II). We performed a multiple hierarchical regression analysis to test for interaction effects. The mediation hypothesis was path-analytically tested in a parallel mediation model by bootstrapping confidence intervals for (in)direct effects. RESULTS: Improvements in self-reported interoception independently predicted positive treatment response, ΔRadj2=8.61%, ΔF(8, 74) = 3.23, p < .01. Prediction effects were moderated by sex, ΔRadj2=5.54%, ΔF(8, 66) = 2.22, p < .05. Post-hoc analyses revealed significant effects of body confidence in women, B = -4.26, t(28) = -2.78, p < .01, and of self-regulation in men, B = -3.21, t(17) = -2.27, p < .05. Effects of somatic symptom relief on treatment outcome were partially mediated by self-reported interoception, total indirect = 2.94 [95% BCa CI 0.99, 5.69]. CONCLUSION: Interoception patterns changed significantly and predicted outcome of hospital treatment in severely depressed patients. Our study could imply the need to consider body sensations additionally as a target for antidepressive treatments. The development of tailored interoceptive interventions in depressive patients represents a promising vision for the future.

The differences between referred and non-referred patients to a psychiatric consultation-liaison service in a general hospital.

OBJECTIVE: The primary aim of this study was to investigate whether there are clinical differences between patients who are referred or not referred for psychiatric consultation and liaison service. The secondary aim was to compare the perspectives of doctors, nurses and patients. METHODS: This naturalistic, prospective and comparative study (N = 294) utilised a control sample of non-referrals (n = 177, consenting 81) and referrals (n = 177, consenting 49). The normality of the data was examined with the Shapiro-Wilk test; bivariate group comparisons were made using Mann-Whitney, Wilcoxon tests and bivariate regression analyses. Statistically adjusted group comparisons were performed with multivariate median regressions. RESULTS: The sample presented limited representativeness. Referred patients were predominantly women, mostly living alone and not working. Compared to the non-referred patients, their disease episode and length of hospital stay were significantly longer, self-efficacy and quality of life lower and psychological stress was higher. For referred patients, there were no differences between the estimations of mental burden and the need for care among doctors, nurses and patients. Self-efficacy and appraisal of one's own burden were the best predictors of the extent of mental symptoms. DISCUSSION: Patients in an admission ward for internal medicine referred to a psychiatric consultation-liaison service displayed a more adverse psychosocial profile and were more psychologically burdened than non-referred patients, but they are also relevantly subsyndromal burdened. Identifying and supporting burdened patients is an endeavour that requires collaborative care, especially in the transition to specialised mental health and to primary care.

Underdiagnosis of psychiatric disorders in people with intellectual disabilities: Differences between psychiatric disorders and challenging behaviour.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the level of mental disorders and challenging behaviour in individuals with intellectual disability (ID) supported by specialized services, but without a prior psychiatric diagnosis, and to compare the levels of different disorders depending on the severity of ID. METHODS: This is a cross-sectional study (N = 142) of population with ID. Inclusion criteria were the following: adult patients with ID and with no previous psychiatric diagnosis prior to this survey. The Wechsler Adults Intelligence Scale-II, the Psychiatric Assessment Schedule for Adults with Developmental Disability checklist and clinical interview, the Diagnostic Assessment for the Severely Handicapped scale and the Inventory for Client and Agency Planning were the assessment tools. RESULTS: A previously undiagnosed mental disorder was found in 29.6% of the sample. The most prevalent mental disorders were major depressive and anxiety disorders. An association between psychiatric comorbidity and challenging behaviour was found only for mild/moderate ID, especially for affective disorders. CONCLUSIONS: The presence of a psychiatric as well as a medical comorbidity is associated with severe ID, unlike challenging behaviour. Clinical limitations of the study have been discussed.

[Waiting Times For Admission Into A Psychotherapeutic Inpatient Treatment - Results of A Prospective Study In South-Württemberg]. / Wartezeiten auf die Aufnahme in eine Psychosomatische Klinik ­ Ergebnisse einer prospektiven Studie in Südwürttemberg.

INTRODUCTION: Waiting times for the admission into a so called psychosomatic hospital in Germany prevent the necessary immediate treatment. They lead to further incapacity for work and chronic manifestation of the disease. It is reported that most psychosomatic hospitals have waiting times, but there are no studies on data on that. Therefore, it was the aim of this study to access prospectively in a defined region, how long it takes for the patients to get an outpatient preliminary talk and thereafter, how long they have to wait for their admission. METHODS: 7 hospitals out of the region of South-Württemberg took part on this study, 2 of them had bigger day hospitals. Data were assessed prospectively in 2015 over 9 months, in total 916 admissions were assessed. RESULTS: The waiting time until a preliminary talk, in which the indication for inpatient treatment was secured, was in the mean 25 days (SD=31). The waiting time after this talk until admission was 56 days (SD=47). Patients who waited for a day treatment had to wait even longer. An urgency remark, given by the therapist of the preliminary talk, as well as a private illness insurance led to shorter waiting times. The diagnosis had no influence on the waiting time. CONCLUSIONS: The waiting times are substantial and imply a burden for the patient and also for the health care system. It is recommended to assess and publish these waiting times on a regularly basis. Politics, but also the actors in the health care system should discuss if and how this deficit can be changed.

Compulsive treatment in psychiatry and self-determination: Anthropology of a liminal encounter.

BACKGROUND: Whereas from a professional point of view, a medical treatment might seem necessary, this treatment might be refused by the patient. In such cases, the patient's ability to determine his will is the key. Any substitutive medical decision is justified by a specific normative framework. OBJECTIVE: The dialectic between a patient's inability to determine his will and the conviction of physicians about the necessity of a medical intervention is reformulated from a medical-anthropological point of view. This dialectic leads to a substitutive decision-making on the basis of a presumed will beyond the elemental will due to the breakdown of mental capacity/legal competence. METHOD: After bracketing out legal concepts, assumptions mirroring canonical conceptions of individual autonomy are carved out. Then the medical encounter involving medically necessary treatments rejected by the patients is analyzed from an anthropological point of view. Hereby, both i) the asymmetry in the understanding and implementation of necessary medical measures, and ii) the emotional resonance capability between physician and patient are discussed. Based on these observations, a criticism of a solely individualistic conception of the mentally ill without any consideration of social interconnections will be developed. Finally, criteria for the assessment of mental capacity as well as for a pragmatic and prudent decision-making under uncertainty are proposed. RESULTS: Mental capacity and legal competence as normative concepts mean the autonomy to act towards sustainable self-care. It can be understood as the competence of judging one's own intentions; this competence includes the balanced interpretation of contingencies and forecasting the scope of consequences. The canonical dialectic between self-sufficiency (corresponding to mental capacity) and subsidiarity (according to substitutive decisions) is based, within the framework proposed here, on treatment asymmetry and personal resonance. When considering substitutive decisions, the relevant social micro systems the patient is embedded in should be taken into account. DISCUSSION: The anthropological examination of the dialectic between autonomy (based on mental capacity) and substitutive decisions leads to a reflection on individual decision-making with uncertain denouement rather than unequivocal, categorical solutions. All stakeholders and relevant others should be taken into account in the decision-making process.

[Natural history after discharge from a hospital psychosomatic treatment - Results of a one-year follow-up]. / Klinischer Verlauf nach stationärer psychosomatischer Behandlung ­ Ergebnisse einer naturalistischen Einjahreskatamnese.

The effectiveness of the inpatient psychosomatic treatment has been documented in various settings. The question of the sustainability of the improvement achieved as well as the prognostic factors is of interest for public health.Primary outcome variables reflect the stability or change in the clinical status of patients one year after the discharge from the inpatient psychosomatic treatment. Secondary outcome variables reflect differences in utilization of medical services between the year before and after admission.One-year naturalistic follow-up of a sample consisting of patients treated in a psychosomatic hospital service by means of 9 clinical and 3 variables for measurement of utilization of medical services. Four measuring points were considered: agreeing at admission (N = 262), discharge (N = 249), 6 months (N = 148) and 12 months (N = 114) after discharge. Differences and associations were assessed by means of t tests and multivariate linear as well as logistic regressions.The subsample with adherence to the study is representative for the whole sample since hardly any differences to the drop-out group were found. A year after discharge, all clinical variables showed significant differences (p < 0.001) compared with clinical status at admission and no significant differences compared with status at discharge (p > 0.05). Three quarters of sample reported a subjective improvement one year after discharge, contrary to results of clinical scales. Medical aftercare was ensured principally by psychotherapists (78 %), followed by general practitioners (63 %), and psychiatrists (44 %). Relevant associations were found between psychotherapy appointments and clinical variables in follow-up.The clinical improvement attained through the psychosomatic hospitalization remain on average stable a year after discharge. Subjective global assessment of health status shows an improvement for the majority of the sample, contrary to results of clinical scales; that is the reason why both assessment approaches have to be considered. Psychotherapy in aftercare could play a prominent role for health preservation.

Sources of meaning in family caregivers of terminally ill patients supported by a palliative nursing care team: A naturalistic three-month cohort study.

ABSTRACTObjective:Our aim was to identify possible patterns of change or durability in sources of meaning for family caregivers of terminally ill patients after the onset of support at home by an outreach palliative nursing team during a three-month survey period. METHOD: The Sources of Meaning and Meaning in Life Questionnaire (SoMe) was administered to 100 caregivers of terminally ill patients at four measurement timepoints: immediately before the onset of the palliative care (t0), and at 1 week, 1 month, and 3 months after t0. Time-dependent changes were assessed for the completed subsample (n = 24) by means of bivariate linear as well as quadratic regression models. Multivariate regressions with dimensions of meaning in life as dependent variables were performed for the whole sample by means of random-effects models: dependent variables changed over time (four timepoints), whereas regressors remained constant. RESULTS: No significant differences were found for psychosocial and clinical variables or for sources of meaning between the uncompleted and completed subsamples. Growth curve analyses revealed no statistically significant but tendentiously parabolic changes for any dimensions or for single sources of meaning. In multivariate models, a negative association was found between patient age, psychological burden of family caregivers, and changes in total SoMe score, as well as for the superordinate dimensions. SIGNIFICANCE OF RESULTS: According to our hypothesis, sources of meaning and meaning in life seem to remain robust in relatives caring for terminally ill family members during the three-month survey period. A parabolic development pattern of single sources of meaning indicates an adjustment process. An important limitation of our study is the small number of participants compared with larger multivariate models because of high dropout rates, primarily due to the death of three-quarters of the participants during the survey period.

Clinical and care intensity differences among patients suffering from somatic diseases electively referred to a consultation and liaison service.

Background This investigation mainly explores possible care differences among patients hospitalized because of medical conditions being electively referred to a psychiatric-psychosomatic consultation and liaison service. Methods A four-year survey ( N = 2518 individuals) based on clinical and care variables selected from the basic documentation. STATISTICS: Chi-square tests, analysis of variance, logistic and multivariate regression analyses, considering statistical modeling assumptions. Results A current psychiatric comorbidity has been found in 75% (less in cancer patients), mainly adjustment and anxiety (45%), mood (22%), and organic mental disorders (12%). The functioning score (Global Assessment of Functioning) was 59.4 and was especially low in patients suffering from unclear medical conditions. The performance status (Eastern Cooperative Oncology Group) amounted to 1.63 and was especially high in patients suffering from orthopedic conditions, infections, and cancer. Each patient received on average of 2.26 (SD = 2.81) contacts and 111 minutes (SD = 160) of total treatment time. In multivariate models, care differences among medical conditions are reduced. Men and older people have received less than the average amount of treatment, but psychiatrically comorbid patients and those with lower functionality and performance status have received more intensive psychological support. Conclusions As a quality feature of consultation and liaison service, patients suffering from psychiatric comorbidity, lower functionality, and lower performance status receive more intensive care and more post-discharge recommendations. Cancer patients and patients with pain as a leading diagnosis as well as strained mothers of hospitalized children have received more intensive treatment by consultation and liaison service despite lower psychiatric comorbidity levels. More attention has to be paid to men and older people independently of their physical condition.

[Effectivity of Inpatient Psychosomatic Treatment - Results of a Naturalistic Two-Year Survey in a Psychosomatic Service at a General Hospital]. / Effektivität stationärer psychosomatischer Behandlung ­ Ergebnisse einer naturalistischen Zweijahresuntersuchung.

BACKGROUND: Hospital psychosomatic treatment matches care expectations of a modern society. Evidence of its effectiveness through investigation in different settings is of importance because of prominent role of psychotherapy in German Healthcare System. OBJECTIVE: First, to explore whether clinical as well as personal resources could improve significantly due to a hospital psychosomatic treatment. Second, to assess possible associations between outcome variables and other variables from the multidimensional profile of the sample. METHOD: The sample consists of all 2014 - 2015 admitted patients who agree with investigation (N=283). Pre-post comparisons of results from validated questionnaires were performed by means of t-tests, including effect sizes. Associations between outcome variables (pre-post differences of clinical and resources related variables) and variables from the multidimensional profile were performed by means of bivariate and multivariate regression tests. Outcome differences were assessed by means of logistic regression models. RESULTS: Drop-out-rate due to refusal of participation amounts 11.8%; from remaining participants uncompleted datasets additional 6.9%; due to declining further participation during hospitalisation additional 4.1% (total drop-out rate amounted 22.8%). Functionality, self-efficacy, disease severity, psychological as well as physical symptom burden, depressiveness, interpersonal concerns, and embitterment improved significantly (p<0.001) displaying effect sizes between 0.39 and 1.42 (average level for clinical variables 0.98). Considerable associations between clinical and resources related variables in both directions were found. 10% of patients reported worsening. DISCUSSION: Psychosomatic hospital treatment is effective according to clinical improvement as well as to perceived quality of treatment. Clinical and resources related variables are positively bidirectional associated notwithstanding the kind of working causality. Robust prognostic factors are hard to identify. CONCLUSIONS: Inpatient psychosomatic treatment is effective when the admission is indicated and the unit accomplishes mandatory quality criteria. The outcome occurs individually and is hard to be predicted. Depressiveness and embitterment could be considered as epiphenomena of all psychosomatic illnesses.

[Psycho-Oncologic Care by a Consultation-Liaison Service - Differences between Oncologic Patients with and without Psychiatric Comorbidity]. / Patientenversorgung im psychoonkologischen Konsiliar- und Liaisondienst ­ Unterschiede zwischen Patienten mit und ohne psychiatrische Komorbidität.

Background: Psycho-oncologic consultation and liaison services (CLS) are mainly psychosomatic oriented teams in acute care hospitals. Their interventions are electively, setting-related or universal like in accredited centers. Objectives: We investigated whether clinical and care-related differences between cancer patients with and without psychiatric comorbidity exist as well as between patients treated in oncologic centers and aside thereof. We also investigated possible differences according to psychiatric as well as to oncologic diagnoses. Method: A 4-year study (2012-15, for center-related comparisons: 2013-15) in a regional hospital (520 beds, 18 wards, 6 oncologic centers) based on data from a basic documentation covering selected clinical as well as care variables. Data was been collected on occasion of each consultation (N=3441 corresponding to 2257 patients). Associations between clinical and care-related variables were identified by means of chi-square, ANOVA, Scheffé post hoc tests as well as by means of multivariate linear and logistic regression models. Results: The sample was on average 64 years old, about 68% women, and they showed a distress about 4.63. Affective disorders were found for 4.4% and adjustment disorders for 7.8% of the sample. Bivariate tests show that patients with psychiatric comorbidity (19%) and patients aside the centers (24%) were highly significant (p<0.001) clinically more impaired and received more intensive care by CLS. Within the centers the psychiatric comorbidity amounted on average 9% (range:4-16%), that was lower than aside the centers (33,5%). Multivariate regression models largely confirm the differences found in bivariate tests; no gender differences were found, but a negative association between age and care density. Discussion: This study supports that psychooncologic CLS follow a good practice, because patients with a higher clinical burden related to psychiatric comorbidity receive more intensive care. Comorbidity quotas found were lower than in other similar German investigations. Conclusions: Oncologic patients with psychiatric comorbidity should be identified by CLS because they have a larger clinical burden and more distress. The fact that older patients receive less face to face interventions may have to be balanced with systemic interventions. Care needs - and not only received care - have to be assessed in further research.

[Are there Associations between Embitterment and Clinical as well as Personality Variables by Psychosomatically Ill Inpatients]. / Gibt es Zusammenhänge zwischen Verbitterung und klinischen sowie persönlichkeitsbezogenen Faktoren bei psychosomatischen Patienten?

BACKGROUND: Understanding of bitterness ranges from a negative general human emotion to a destructive complex affekt due to a non adequate processed affront or resentment. OBJECTIVE: Relevant associations between kinds of bitterness and clinical as well as personality-related variables in hospitalized psychosomatic patients were examined. METHOD: Prospective naturalistic study over 14 months of consecutive admitted psychosomatic patients without exclusion criteria (N=166). General bitterness and 4 subscales were investigated on the basis of the Berner Verbitterungs-Inventar (BVI), personality traits on the basis of BFI-10, and clinical variables mainly on the basis of validated instruments (HoNOS, BDI, HADS, GAF, CGI, IIP-D, BSCL, comorbidity, duration of illness and structure as well as conflict-load according to OPD-2). Differences among levels of bitterness were examined with ANOVA tests, relationships between bitterness and clinical as well as personality-related variables using multivariate linear and multinomial regression models. RESULTS: The general bitterness falls within the average range. ANOVA models show higher scores for neuroticism, IIP, BDI, HADS, and BSCL when bitterness is above-average. In multivariate regression analyses, BDI, BSCL and neuroticism are positively associated with bitterness, whereas GAF, illness duration, and conscientiousness are negatively associated with bitterness. Diagnoses, severity of disease and burden of conflicts as well as level of organization of personality are not associated with bitterness. Models explain 11-39% of variance of bitterness. DISCUSSION: Bitterness in psychosomatic patients is hardly associated with personality variables, diagnoses, and psychopathological burden with the exception of depressiveness and neuroticism. Burden of interpersonal concerns may better explain bitterness than psychopathology or personality. CONCLUSIONS: Bitterness could be interpreted as a theoretical construct widely independent from severity of disease, personality, and diagnosis, showing importance in clinical practice.