Christine Gallas

Das Klinisch Psychologische Diagnosesystem 38 (KPD-38)

Zusammenfassung. Mit dem KPD-38 steht ein neues Instrument fur die Qualitatssicherung und das Ergebnismonitoring in der Psychotherapie und psychosomatischen Medizin zur Verfugung. Im vorliegenden Beitrag werden die Entwicklung des KPD-38 und erste Erfahrungen aus dem Einsatz in der Qualitatssicherung beschrieben. Das Instrument wurde einer Bevolkerungsstichprobe (N = 2066) sowie einem Patientenkollektiv aus der stationaren Psychotherapie (N = 351) vorgelegt. Es wurden Prufungen der Validitat, Reliabilitat, der computergestutzten Vorgabe, Sensitivitat und Spezifitat durchgefuhrt. Neben testokonomischen Gesichtspunkten sprechen insbesondere die deutlichen Belege der Validitat des KPD-38 fur den Einsatz in diesem speziellen Anwendungsbereich. Die vielversprechenden Hinweise auf seinen Nutzen fur die Behandlungs- und Versorgungsplanung durch therapiebegleitende Ruckmeldungen lassen weitere Detailstudien als lohnend erscheinen.

New prospects for process research in group therapy: Text-based process variables in psychotherapeutic Internet chat groups.

Abstract This study focuses on the operationalization and validation of text-based process variables in psychotherapeutic Internet chat groups. The process variables activity, outdegree (OD; i.e., the frequency at which a group member addresses others in the group), and indegree (ID; i.e., the frequency at which a group member‘s name is mentioned by other group members or by the therapist [IDT]) were operationalized. Using 1,046 session transcripts from 130 participants of an Internet chat aftercare program, the authors studied the concurrent and predictive validity of activity, OD, ID, and IDT and of 52 text-based variables comprising linguistic, emotional, and cognitive aspects. Results showed consistent correlations between psychometric group ratings and the text-based variables ID, OD, and activity. The predictive validity of the variables IDT, ID, and activity was rather low but as good as the predictive validity of the psychometric ratings. The clinical implications of the results are discussed.

[Cyberstalking: prevalence and impact on victims].

OBJECTIVE The present study was designed to investigate prevalence and types of cyberstalking and its impact on mental health. METHOD Internet survey of 6379 participants in the Web-based social network Studi-VZ. RESULTS The prevalence of cyberstalking was 6.3 %. Cyberstalking appears to be a frequently occurring phenomenon. Contrary to earlier assumptions, not based on empirical studies, there are striking similarities of cyberstalking and stalking in the real world. The gender distribution is comparable to real life stalking: Most of the victims are female and most of the perpetrators are male. Like other forms of stalking in the real world, cyberstalking occurs most often in the context of ex-partner relationships and contacts with friends, acquaintances and work colleagues. Compared to non-victims, victims of cyberstalking scored significantly poorer on the WHO-5 well-being index. CONCLUSION Due to the increasing use of web-based social networks psychiatrists and psychotherapists have to become experts in the issue of cyberstalking since victims will frequently ask them for help. As cyberstalking does not appear to be a separate diagnostic entity, similar counselling techniques that are applied for other forms of stalking should be provided.

Utilization of outpatient psychotherapy and its implications for service provision

Time structure of outpatient psychotherapy is important for clinical practice, as well as for theoretical and cost-effectiveness reasons. In this paper, important time variables (session number and frequency, therapy duration, utilization of the allocated session contingent, extension of therapy) are studied in a sample of n=714 German insurees in outpatient psychotherapy over a four-year period. Session number and duration of therapy were modelled with survival analysis, Cox regression was used to study the influence of covariates assessed at the beginning of therapy. Results are reported separately for the three therapy approaches financed by the German health insurance system: psychoanalytic psychotherapy (AP), psychodynamically-oriented therapy (TP) and cognitive-behavioral therapy (VT). Results show median session numbers of 25 (VT), 42 (TP) and 101 (AP) and a therapy duration of 12.8 (VT), 16.7 (TP) and 23.5 (AP) months. Initial therapeutic alliance was negatively associated with therapy duration and session number in AP. In TP and VT, a negative association between age and treatment duration was observed. 72.5% of the total session contingent was utilized and 38.4% of the participants applied for additional therapy sessions. An extension of psychotherapy happened more frequently 1) in psychoanalytic treatments and 2) in participants with higher initial psychological distress. Results show that the utilization of therapeutic resources differs from both theoretical concepts and fixed contingents allocated by health insurances. Potential implications for the allocation of psychotherapeutic resources are discussed.

Aufgaben der Allgemeinpsychiatrie und der Forensischen Psychiatrie bei Stalking

Stalking ist in der Bevolkerung von Industrienationen ein weit verbreitetes Phanomen, die Lebenszeitpravalenz betragt uber 11 %. Hinter den relativ gleichformig erscheinenden Stalkingverhaltensweisen verbergen sich sehr unterschiedliche Tater, Tater-Opfer-Beziehungen und Motivationsstrukturen. Die in der Arbeit vorgestellte multiaxiale Stalkingklassifikation betont die Bedeutung einer psychopathologischen Diagnostik. Im Hinblick auf den Stalker hat der Psychiater wichtige Aufgaben bei der Diagnostik, Schuldfahigkeits- und Prognosebegutachtung, Therapie und der Zuweisung zur Psychiatrie oder Masregelvollzugsklinik. Bei den Stalkingopfern ergeben sich fur den Psychiater ebenfalls wichtige Aufgaben bei der Diagnostik, Behandlung und Begutachtung.

Krankenkassengestütztes Case-Management verbessert kostenneutral die Behandlungsqualität bei affektiven Störungen

OBJECTIVE Improvement of depression treatment by health insurance based case-management. Criteria of improvement were a higher treatment rate of patients suffering from affective disorders or depression by psychiatrists or psychotherapists than by general practitioners or family doctors and sickness fund payments. METHODS Training of health insurance account managers (characteristics of depression, counselling and, case management techniques). Evaluation of outcomes during 12-months against a control group of account managers without training. RESULTS Intervention group: 87.8 % patients with in average 13.5 contacts to psychiatrists or psychotherapists; control group: 82.6 % patients with 11.8 contacts. The difference was statistically significant. Health insurance payments did not differ. CONCLUSIONS A higher treatment rate by psychiatrists and psychotherapists can be achieved by health insurance-based case-management without a cost-increase.

Zur diskriminativen Validität des Inventars zur Erfassung Interpersonaler Probleme (IIP)

Zusammenfassung. Theoretischer Hintergrund: Das Inventar zur Erfassung Interpersonaler Probleme (IIP) weist konzeptionelle Uberschneidung mit Zirkumplex-Modellen der Personlichkeit und den Diagnosekriterien von Personlichkeitsstorungen (PS) auf. Fragestellungen: (1) Diskriminieren die Skalen des IIP Patienten1Lediglich aus Grunden der Lesbarkeit verwenden wir die maskuline Schreibweise. Selbstverstandlich sind mit Patienten und Therapeuten stets auch weibliche Personen gemeint. mit PS praktisch bedeutsam von anderen Patienten? (2) Eignet sich das IIP bzw. der interpersonale Zirkumplex zur Differenzierung spezifischer PS? Methode: Die IIP-Werte von n = 368 Patienten mit PS in stationarer psychotherapeutischer Behandlung und einer gleich grosen Vergleichsgruppe von Patienten ohne PS derselben Kliniken wurden untersucht. Ergebnisse: Die Diskrimination zwischen den Gruppen resultierte in einer signifikanten Diskriminanzfunktion mit einer Reklassifizierungsgute von 63%. Die Verwendung ipsatierter Skalenwerte f...