Andreas Jähne

Training of Dental Professionals in Motivational Interviewing can Heighten Interdental Cleaning Self-Efficacy in Periodontal Patients

Background: The success of periodontal therapy depends on the adherence of patients to professional recommendations. The aim of this study was to investigate the influence of a workshop in motivational interviewing (MI) on non-surgical periodontal treatment performed by dental students. Materials and Methods: In the experimental group patients with periodontitis were treated by students trained in MI, while in the control group patients were treated by students who had not been trained in MI. Clinical oral parameters were assessed by a blinded periodontist in addition to the evaluation of psychological questionnaires given before and after the non-surgical periodontal treatment (6 months). Conversations between patients and students were recorded and rated with the Motivational Treatment Integrity Code (MITI-d) by a blinded psychologist. Results: There were 73 patients in the MI group and 99 patients in the control group. The MI group showed significantly higher scores in the MITI-d analysis. Regression analysis showed that there were no significant differences between groups with regard to plaque level, gingival bleeding, pocket depth reduction or bleeding upon probing. However, patients in the MI-group showed significantly higher interdental cleaning self-efficacy than patients in the control group (MI = 19.57 ± 4.7; control = 17.38 ± 6.01; p = 0.016). Conclusion: Teaching MI to dental students resulted in a significant improvement in the self-efficacy of interdental cleaning in patients compared to a control group of non-trained students, but no improvement in other aspects of non-surgical periodontal therapy. The study also showed that an 8-h workshop with supervision significantly improved the MI-compliant conversations of dental students without requiring more conversation time.

Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit@@@Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

Behandlung von schädlichem und abhängigem Tabakkonsum

Kapitel 4 umfasst alle Leitlinienempfehlungen zur Behandlung von tabakbezogenen Storungen mit ihrem Hintergrundtext und Empfehlungen zur weiteren Forschung. Inhalt sind: die Forderung der Ausstiegsmotivation, die Indikation und Durchfuhrung niederschwelliger Interventionen, Masnahmen zur Harm Reduction, psychotherapeutische, pharmakologische und somatische Ansatze, Techniken und Methoden zur Unterstutzung der Tabakabstinenz und Ruckfallprophylaxe. Spezielle Empfehlungen werden fur allgemeine Indikationsfelder (Alter, Geschlecht, Schwangerschaft) sowie somatische und psychische Komorbiditaten auf evidenzbasierter Basis mit den zugehorigen Hintergrundempfehlungen formuliert. Den Abschluss bilden Empfehlungen zu Setting und Versorgungssituation. Drei klinische Behandlungsalgorithmen stellen den allgemeinen Therapieprozess sowie die psychotherapeutischen und pharmakologischen Prozesse von der ersten Problematisierung des Tabakkonsums bis zum Erreichen der Abstinenz dar. Zum Verstandnis der Empfehlungstabellen wird das vorherige Lesen der Methodenabschnitte der Zusammenfassung (Kap. 1) dringend empfohlen, zum Verstandnis der klinischen Algorithmen Abschn. 2.1.4.

S3-Leitlinie Tabakentwöhnung: Pharmakotherapie

Einleitung: Ausgangslage: In Deutschland sind Nikotinersatzpraparate, Bupropion und Vareniclin fur die Unterstutzung des entwohnungswilligen Rauchers zugelassen. Einige weitere Substanzen werden als Off-label Alternativen benannt. Das Ziel der pharmakologischen Behandlung ist in erster Linie die Uberwindung der Entzugssymptomatik. Damit verbunden ist die Erhohung der langfristigen Abstinenzquoten. Ziel: Innerhalb der geplanten S3-Leitlinie „Tabakentwohnung“ ist ein Kapitel zu Empfehlungen hinsichtlich der pharmakologischen Therapie vorgesehen (Kapitel 4). Methode: Verantwortlich fur die Erstellung des Leitlinientextes unter Federfuhrung der Deutschen Gesellschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) und der Deutsche Gesellschaft fur Suchtforschung und Suchttherapie e.V. (DG-Sucht) in Kooperation mit zahlreichen weiteren Fachgesellschaften ist eine Arbeitsgruppe, die nach Durchfuhrung einer systematischen Literaturrecherche die Aufgabe hat, die vorhandenen Quellleitlinien und die identifizierte Literatur (Metaanalysen und RCTs) zu bewerten und Empfehlungen zu erarbeiten. Diskussion/Ergebnisse: Vorgestellt werden die Ergebnisse der Literaturauswertung, der Konsensuskonferenz der Leitlinienarbeitsgruppe, die erarbeiteten Empfehlungen zur Pharmakotherapie sowie die Inhalte der Hintergrundstexte. Schlussfolgerung: Die Bearbeitung des Kapitels „Pharmakotherapie“ ist voraussichtlich bis Mitte 2013 abgeschlossen und konsentiert. Fur Ende 2013 ist die Veroffentlichung der Empfehlungen geplant. Firmenbeziehungen: Sponsoring fur Pharmastudien durch Alkerme, McNeil, Pfizer

Entzug überwinden, Rückfall verhindern

ZusammenfassungEin Rauchstopp lohnt sich für alle Patienten, wird aber durch körperliche und psychische Abhängigkeit erschwert. Effektive Tabakentwöhnung zielt neben Verstärkung der Abstinenzmotivation auf Überwindung von Entzugssymptomen und Rückfallprophylaxe. Die höchste Wirksamkeit erzielt eine Kombination biologischer und psychologischer Therapieverfahren. Neben Selbsthilfemanualen, Telefonberatungen oder Gruppentherapien kommen Nikotinsubstitution und medikamentöse Intervention zum Einsatz. Wichtig ist die Nachbegleitung des Patienten nach dem Rauchstopp.