Rainer Richter

Use of alternative / complementary therapy in breast cancer patients – a psychological perspective

Abstract. The objectives of this study were to assess the additional use of alternative (complementary) therapies in patients with breast cancer who were receiving conventional treatment and to compare patients using alternative therapies with patients receiving only conventional treatment with special reference to psychological adaptation, causal attribution and quality of life. A sample of 117 female out-patients with a diagnosis of breast cancer filled in the following assessment instruments: FQCI (Freiburg Questionnaire for Coping with Illness), PUK (Causal Attribution Questionnaire), EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), POMS (Profile of Mood States), and a self-developed questionnaire on alternative therapies. Nearly half the patients (47%, n=55) reported that they had used alternative therapies in addition to conventional treatment. The methods applied most frequently were nutrition-related measures (special drinks, vitamin preparations and wholefoods – each applied by about 50% of users), mistletoe preparations (49%), trace elements (47%), and homeopathy (31%). Compared with patients receiving only conventional treatment, the users of alternative therapy were younger and better educated. Users developed a more active style of illness coping than non-users and showed more religious involvement. Patients using a large number of alternative therapies (>3) tended to adopt a more depressive coping style than those using only a small number (≤3). For a substantial proportion of cancer patients alternative therapies apparently fulfil an important psychological need. However, a subgroup of patients using many alternative therapies seem to have considerable adjustment problems. In dealing with cancer patients the treatment team should be aware of both these groups.

Bindung und Psychotherapie

ZusammenfassungIn einer prospektiven naturalistischen klinischen Studie wurde bei 65 Patienten1 (Wir verwenden im folgenden den Begriff „Patienten” und schließen die weiblichen Patienten mit ein.) mit verschiedenen psychosomatischen Störungen untersucht, in wie weit der Erfolg einer stationären Psychotherapie (mittlere Dauer 7 Wochen) aus einer eingangs bestimmten Bindungsqualität (Erwachsenen-Bindungsprototypen-Rating – EBPR – nach Strauß und Lobo-Drost) und aus den interpersonalen Problemen (IIP nach Horowitz et al.) vorhergesagt werden kann. Das Ausmaß, mit dem das individuelle Therapieziel (GAS) erreicht wurde, konnte (schwach, aber signifikant) aus der Bindungssicherheit, nicht hingegen aus den Bindungsprototypen vorhergesagt werden. Der Therapieabbruch als weitere Outcomevariable korrelierte ebenfalls nur schwach, aber signifikant mit einer Skala des IIP (Dominanz).SummaryThe aim of the study was to predict the psychotherapy-outcome in 65 inpatients with psychosomatic disorders by the ”Erwachsenen-Bindungsprototypen-Rating – EBPR (i.e. Adult Attachement-Prototypes Rating) – Strauß u. Lobo-Drost” and by interpersonal problems (IIP; Horowitz). Only attachment security (but none of the attachment prototypes) was a weak but significant predictor of individual therapeutic goal attainment. Premature breaking off, another outcome criterium, was significantly correlated with ”autocratic” interpersonal behavior.

Psychosocial care by general practitioners--where are the problems? Results of a demonstration project on quality management in psychosocial primary care.

Objective: Since 1987, psychosocial services have been a part of the primary care setting in Germany. In the framework of an eight-center national demonstration program, problems in the diagnosis and therapy of psychosocial problems and psychosomatic disorders were assessed. Methods to improve quality were also implemented. Method: General practitioners (n = 191) from six regions participated in the study. One thousand three hundred and forty-one treatment episodes of patients with predominantly psychosocial symptoms were documented. Differences between psychosocial strain, treatment, and outcome were determined by analyses of variance. Results: Anxiety (62%), depression (51%), and marital/family conflicts (44%) were the most frequent symptoms. Psychosocial treatment was offered more often to those patients who had the highest level of anxiety and depression. Patients with pain and without a psychological attribution to their illnesses were offered less psychosocial treatment and suffered worse results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-oriented case conferences, consultation services, and collaborative groups. Conclusions: These initial results are promising. A process of internal quality management has been initiated. Some of the physicians still resist documenting the data. Patients with somatic symptoms without psychological attribution may need special psychosocial interventions to improve their outcomes.

Assessing Psychosocial Vulnerability and Care Needs of Pretransplant Patients by Means of the INTERMED

OBJECTIVE We investigated whether the INTERMED, a generic instrument for assessing biopsychosocial case complexity and direct care, identifies organ transplant patients at risk of unfavourable post-transplant development by comparing it to the Transplant Evaluation Rating Scale (TERS), the established measure for pretransplant psychosocial evaluation. METHOD One hundred nineteen kidney, liver, and heart transplant candidates were evaluated using the INTERMED, TERS, SF-36, EuroQol, Montgomery-Åsberg Depression Rating Scale (MADRS), and Hospital Anxiety & Depression Scale (HADS). RESULTS We found significant relationships between the INTERMED and the TERS scores. The INTERMED highly correlated with the HADS,MADRS, and mental and physical health scores of the SF-36 Health Survey. CONCLUSIONS The results demonstrate the validity and usefulness of the INTERMED instrument for pretransplant evaluation. Furthermore, our findings demonstrate the different qualities of INTERMED and TERS in clinical practice. The advantages of the psychiatric focus of the TERS and the biopsychosocial perspective of the INTERMED are discussed in the context of current literature on integrated care.

The role of life event stress in the pathogenesis of duodenal ulcer

The role of life events in the development of duodenal ulcer was examined. Patients with duodenal ulcer and with functional dyspepsia completed a modified version of the Social Readjustment Rating Scale, ticking the events experienced within the last 6 months. This was done just before the gastroscopy on which diagnoses were based. Neither in total life change score nor in perceived stress were significant differences between groups observed. In one category of events ulcer patients had even lower values than the controls. Our results do not support the widely held notion that stressful life events trigger onset or relapse of duodenal ulcer.

Die psychosomatische Grundversorgung älterer PatientInnen

Altere Menschen gehoren zu den Personengruppen, die im Hinblick auf den Zugang zur psychotherapeutischen/psychiatrischen Versorgung moglicherweise benachteiligt sind, andererseits Hausarzte besonders haufig konsultieren. In diesem Beitrag wird daher der Frage der Versorgungsqualitat in der Primarversorgung nachgegangen, wozu der Baseline-Datensatz der multizentrischen Verbundstudie „Qualitatssicherung in der Psychosomatischen Grundversorgung“ auf Altersunterschiede in Struktur-, Prozes- und Ergebnisdaten analysiert wurde.