Martina de Zwaan

Der Zusammenhang zwischen psychoonkologischem Betreuungsbedarf, Wunsch nach Unterstützung und tatsächlicher Behandlung bei Krebspatientinnen und -patienten

BACKGROUNDnThe aim of the study was to examine the association between the need for psychosocial support, the patients desire for support and the actually received psychosocial interventions in cancer patients.nnnMETHODSnThe need for psychosocial support was assessed with the Hornheider Screening Instrument (HSIu2009³u20094) in 455 cancer patients. The subjective desire for psychosocial support was assessed with a single question. In addition, the actually received psychosocial interventions were retrieved from the hospital documentation system of the psycho-oncology service.nnnRESULTSnOverall, 41.8xa0% of the participants received a positive screening result indicative for the need for psychosocial support, 19.8xa0% reported a desire for support, and 41.5xa0% actually received at least one psychosocial intervention. The agreement between objective need and subjective desire for psychosocial support was low (ku2009=u20090.352). Received psychosocial interventions were significantly associated with the subjective desire but not with the objective need for support as assessed with the HSI.nnnCONCLUSIONSnThe low associations between need and desire for psychosocial support as well as between need and actually received psychosocial interventions suggest that the decision for psychosocial support should be based on the objective as well as the self-reported need for help.ZusammenfassungGrundlagenZiel der Studie war es, den psychoonkologischen Betreuungsbedarf, den Wunsch nach Betreuung und die tatsächlich stattgefundene psychoonkologische Betreuung zu erheben und zueinander in Beziehung zu setzen.MethodikDer psychoonkologische Betreuungsbedarf wurde mit dem Hornheider Screening Instrument (HSIu2009³u20094) bei 455 onkologischen Patientinnen und Patienten erfasst und um die Frage nach dem subjektiven Betreuungswunsch ergänzt. Die tatsächlich erfolgte psychoonkologische Betreuung wurde der klinikinternen Basisdokumentation des psychoonkologischen Dienstes entnommen.Ergebnisse41,8xa0% der Befragten erzielten ein positives Screeningergebnis im HSI, 19,8xa0% gaben einen subjektiven Wunsch nach Betreuung an und 41,5xa0% erhielten tatsächlich zumindest einen psychoonkologischen Kontakt. Die Übereinstimmung zwischen objektivem Bedarf und subjektivem Wunsch nach Betreuung war niedrig (ku2009=u20090,352). Psychoonkologische Kontakte waren zudem signifikant mit dem Wunsch nach Betreuung nicht aber mit dem im HSI ermittelten Betreuungsbedarf assoziiert.SchlussfolgerungenDie geringen Zusammenhänge zwischen Betreuungsbedarf und -wunsch sowie zwischen Betreuungsbedarf und tatsächlich erfolgter Betreuung verdeutlichen, dass die Indikationsstellung für eine psychoonkologische Intervention unter Einbezug sowohl objektiver Screening-Instrumente als auch subjektiver Patientenbedürfnisse erfolgen sollte.SummaryBackgroundThe aim of the study was to examine the association between the need for psychosocial support, the patients’ desire for support and the actually received psychosocial interventions in cancer patients.MethodsThe need for psychosocial support was assessed with the Hornheider Screening Instrument (HSIu2009³u20094) in 455 cancer patients. The subjective desire for psychosocial support was assessed with a single question. In addition, the actually received psychosocial interventions were retrieved from the hospital documentation system of the psycho-oncology service.ResultsOverall, 41.8xa0% of the participants received a positive screening result indicative for the need for psychosocial support, 19.8xa0% reported a desire for support, and 41.5xa0% actually received at least one psychosocial intervention. The agreement between objective need and subjective desire for psychosocial support was low (ku2009=u20090.352). Received psychosocial interventions were significantly associated with the subjective desire but not with the objective need for support as assessed with the HSI.ConclusionsThe low associations between need and desire for psychosocial support as well as between need and actually received psychosocial interventions suggest that the decision for psychosocial support should be based on the objective as well as the self-reported need for help.

Psychische Komorbidität, Körperbildprobleme und psychotherapeutische Interventionen bei Brandopfern: ein Überblick

Due to progress in burn treatment, more patients even with severe burn injuries survive. Despite this positive development, however, there are still negative somatic and mental consequences. These include the life-long care of scars and pain. In addition, posttraumatic-stress disorder and depression are common consequences. Also distress due to disfigurement and body image problems have to be considered, since this is likely to result in social withdrawal, low self-esteem, and reduction of quality of life. Overall, the impact of mental strain on burn victims is quite high. Therefore, psychotherapeutic treatment approaches should be integrated into the care of patients with burns. This might be helpful for both coping and compliance with long-term treatment. This paper provides a review of the mental co-morbidity of burn victims and of psychotherapeutic treatment approaches focusing on changes in body image and the respective social consequences.

Psychische Belastung und Psychosomatischer Behandlungswunsch von Patienten mit Pulmonaler Hypertonie

BACKGROUNDnThe study investigated the level of mental distress in patients with pulmonary hypertension (PH) and assessed the use of and the wish for psychosomatic treatment.nnnMETHODSnA total sample of n=187 outpatients participated in the cross-sectional survey. The short form of the Patient Health Questionnaire (PHQ-D), the EuroQol (EQ-5D) and a questionnaire assessing the wish for psychosomatic treatment were applied.nnnRESULTSn50.6% of the patients exhibited depressive symptoms of varying degrees, 19.2% showed symptoms of major depression. 14.8% of the pa-tients reported panic attacks, and 7.1% demonstrated symptoms of a panic syndrome. Quality of life was low (EQ-5D VAS M=60). Experience with outpatient or inpatient psychotherapy was reported by 23.4% and 8.6% of the patients, respectively. 56.5% reported a wish for psychosomatic treatment.nnnCONCLUSIONSnPH-Patients are more likely to suffer from mild or subthreshold depressive syndromes, but are very interested in psychosomatic treatment. The implementation of psychosomatic interventions into clinical practice would be desirable.

Komorbidität von Diabetes mellitus Typ 2 und Night Eating

The core symptoms of the night eating syndrome (NES) are overeating in the evening and/or nocturnal awakenings with the ingestion of food. The aim of this study was to examine metabolic and psychopathological differences between patients with type 2 diabetes mellitus with and with-out night eating (NE). A total of 226 individuals with type 2 diabetes mellitus participated in the study. Night eating (NE), defined as the ingestion of ≥25% of the daily food intake in the evening or nighttime, was reported by 28 (12.4%) of the participants. In addition, diabetes-related variables, eating and dieting behavior as well as eating-related and general psychopathology (depression, quality of life) were assessed. Compared to pa-tients without NE patients with NE showed higher HbA1c values, higher scores on the disinhibition and the perceived hunger scale, lower scores on the quality of life scale and higher depression scores.

Evaluation des einjährigen multimodalen Therapieprogramms DOC WEIGHT® 1.0 zur Gewichtsreduktion bei Patienten mit Adipositas Grad II und III

According to treatment guidelines, treatment for obesity (body mass index [BMI]≥30.0u2009kg/m(2)) comprises nutritional, physical, and behavioral interventions. However, evidence-based programs for the treatment of severe obesity are rare. In an uncontrolled study, a total of 190 participants (BMI≥35.0u2009kg/m(2)) of the one-year multimodal treatment program DOC WEIGHT(®) 1.0 were assessed at pre- (t0) and post-intervention (t1) as well as at 1-year follow-up (t2). Results revealed significant improvements from t0 to t1 in body weight, waist circumference, eating disorder psychopathology, and quality of life that persisted to t2. Long-term multimodal outpatient treatment for severe obesity focusing on behavior modification is promising, however, high rates of loss to follow-up limit explanatory power. To improve evidence, consecutive evaluation is intended.

Familie, Partnerschaft, Bildung und berufliche Situation bei Patientinnen mit Anorexia nervosa

ZusammenfassungDer Einfluss von Familie, Partnerschaft, Bildung oder beruflicher Situation auf Entstehung und Aufrechterhaltung der Anorexia nervosa (AN) wurde vielfach diskutiert. Bereits in den ersten Beschreibungen der Erkrankung wurde detailliert Bezug zu Dimensionen des Familiensystems genommen. Dennoch ist die Evidenz zur Auswirkung dieser Variablen auf den Verlauf der Krankheit bis heute unklar. Randomisierte, kontrollierte Studien zu den Effekten von Psychotherapie geben wenige Information, wie diese Variablen bei den teilnehmenden Patientinnen verteilt sind, insbesondere auch, welchen Einfluss sie auf das Outcome der Studien haben. Ziel vorliegender Arbeit war es, die Patientinnen aus der Studie „Anorexia Nervosa Treatment of Outpatients“ (ANTOP) – der weltweit größten ambulanten Therapiestudie zu AN – hinsichtlich der Einflüsse von Familie, Partnerschaft und Berufskontext auf den Behandlungserfolg zu untersuchen. Die Ergebnisse zeigen Hinweise, dass Patientinnen in der ANTOP-Studie einen höheren Bildungsstand als der altersentsprechende Bevölkerungsdurchschnitt haben. Gleichzeitig scheinen sie weniger häufig in einer institutionalisierten Partnerschaft zu sein. Bezüglich der Berufstätigkeit gibt es keine Unterschiede. Erhobene Variablen zu Familie, Partnerschaft, Bildung und beruflicher Situation hatten keinen prädiktiven Wert bezüglich des gewichtsbezogenen Therapie-Outcome in der ANTOP-Studie.AbstractThe influence of family, partnership, education and occupational situation on the onset and maintenance of anorexia nervosa has been widely discussed. Even in the first descriptions of the disease detailed reference was made to the dimensions of the family system. Nevertheless, the evidence on the effect of these variables on the course of the disease is still unclear. Randomized, controlled studies on the effect of psychotherapy provide little information about how these variables are distributed among participating patients and especially what influence they have on the outcome of the studies. The aim of this study was axa0detailed characterization of participants of the worldwide largest outpatient therapy study, the anorexia nervosa treatment of outpatients (ANTOP) study with respect to the relevance of family, partnership and the occupational situation on treatment success. The results show indications that patients in the ANTOP study have axa0higher education level compared to the average age-matched German population. At the same time, they appear to be less frequently in an institutionalized partnership. There were no differences in professional activity and occupation. Variables on family, partnership, education and job situation had no predictive value for weight-related treatment outcome in the ANTOP study.

Angehörigenarbeit bei essgestörten Patientinnen

The purpose of this article is to describe the background and procedure of a skills training program provided for carers of patients suffering from anorexia or bulimia nervosa. Caring for someone suffering from an eating disorder is associated with psychological distress and may lead to unhelpful interactive behaviours that maintain the illness. Recent investigations in supporting carers, especially skills sharing workshops that target interpersonal maintaining factors are described. A 5-session training concept in teaching basic skills and information about eating disorders to carers in order to improve caregiving burden and reduce interpersonal maintaining factors like expressed emotions (EE) is currently examined in our department. Design and content will be described in detail. Carers and sufferers perceptions of the impact of the sessions and acceptance of the provided skills training are reported.

Störungen im Essverhalten in der deutschen Bevölkerung

In a representative German population sample, the prevalence of eating disturbances was determined using the Eating Disorder Examination-Questionnaire. Overall, 3,9% revealed eating disturbances. In particular, young women and obese persons had an increased likelihood of these disturbances, but men and older persons were concerned as well. Further research is warranted on eating disturbances across the life span, both sexes and weight status.

Ergebnisse einer repräsentativen Befragung zur Durchführung der psychosozialen Begutachtung vor Lebendnierenspende in Deutschland

Aim Since there is no consensus about how to perform the predonation psychosocial evaluation of living kidney donor candidates, this is conducted differently in German transplant centers. Thus, the goal of the study was to learn more about how psychosocial evaluations are currently conducted in German transplant centers. Methods The psychosocial evaluators of the 38 transplant centers performing kidney transplantations in 2015 were contacted and asked to participate in an anonymous online survey. Results Psychosocial evaluators from 28 (75%) transplant centers responded. In only 30 (4%) of the evaluations contraindications for donation were reported. In most centers the psychosocial evaluation was performed after the completion of all medical tests. The evaluations were realized after only short waiting periods and were reported to be time-consuming. Financial reimbursement was mainly realized by internal cost allocation. In most centers the evaluators used semi-structured interviews. Still, there was limited consensus about structure and content of the psychosocial evaluation. Conclusion Standardization of the psychosocial evaluation process could be helpful to enable comparisons between transplant centers and to achieve equal opportunities for the potential living kidney donors and recipients.

Schematherapie bei Essstörungen – Ein integrativer Ansatz zur Verbesserung des Therapieoutcomes

Despite evidence-based psychotherapeutic treatment approaches such as cognitive behavioral therapy and psychodynamic therapy eating disorders still pose a challenge to therapists and patients alike. Eating disorders are associated with a high comorbid prevalence of personality disorders and other psychological axis-I-disorders, show highdrop-out rates and relapse rates and anorexia nervosa has the highest mortality rate compared to all psychiatric disorders. Even self-motivated patients frequently fail to achieve the treatment goals like developing a normal eating behavior, gaining weight, and changing the underlying dysfunctional behavioral patterns and cognitions. We will present a schematherapeutic approach with experiential methods, integrated in evidence-based CBT, with the intention to improve motivation and therapeutic outcome.