Roman Schleifer

Predicting medical students' current attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry: A cross-sectional study in four European countries

Psychiatry as a medical discipline is becoming increasingly important due to the high and increasing worldwide burden associated with mental disorders. Surprisingly, however, there is a lack of young academics choosing psychiatry as a career. Previous evidence on medical students’ perspectives is abundant but has methodological shortcomings. Therefore, by attempting to avoid previous shortcomings, we aimed to contribute to a better understanding of the predictors of the following three outcome variables: current medical students’ attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry. The sample consisted of N = 1,356 medical students at 45 medical schools in Germany and Austria as well as regions of Switzerland and Hungary with a German language curriculum. We used snowball sampling via Facebook with a link to an online questionnaire as recruitment procedure. Snowball sampling is based on referrals made among people. This questionnaire included a German version of the Attitudes Toward Psychiatry Scale (ATP-30-G) and further variables related to outcomes and potential predictors in terms of sociodemography (e.g., gender) or medical training (e.g., curriculum-related experience with psychiatry). Data were analyzed by linear mixed models and further regression models. On average, students had a positive attitude to and high general interest in, but low professional preference for, psychiatry. A neutral attitude to psychiatry was partly related to the discipline itself, psychiatrists, or psychiatric patients. Female gender and previous experience with psychiatry, particularly curriculum-related and personal experience, were important predictors of all outcomes. Students in the first years of medical training were more interested in pursuing psychiatry as a career. Furthermore, the country of the medical school was related to the outcomes. However, statistical models explained only a small proportion of variance. The findings indicate that particularly curriculum-related experience is important for determining attitudes toward psychiatry, interest in the subject and self-predicted professional career choice. We therefore encourage the provision of opportunities for clinical experience by psychiatrists. However, further predictor variables need to be considered in future studies.

Der Begriff der Therapieresistenz bei unipolaren depressiven Störungen aus medizinischer und aus rechtlicher Sicht – eine Standortbestimmung im Nachgang zu BGE 9C_13/2016

Der Beitrag befasst sich mit der bundesgerichtlichen Rechtsprechung zur allfalligen invalidisierenden Wirkung bestimmter depressiver Storungen. Dabei steht fur das Bundesgericht im Zentrum, ob die betreffende Einschrankung therapieresistent ist. Das Bundesgericht legt dar, dass es sich um seltene Konstellationen handle, in denen bei Depressionen leichter oder mittelgradiger Natur eine Therapieresistenz bestehe. Im Beitrag wird aus medizinischer Sicht eine Definition der chronischen depressiven Storung und der therapieresistenten Depression gegeben. Dabei wird genau untersucht, wann eine Therapieresistenz angenommen werden muss. Bei chronischen Verlaufen mit einer z.T. mehrjahrigen Krankheitsdauer kann aus medizinischer Sicht nicht mehr mehrheitlich von einer gunstigen Prognose ausgegangen werden. Mindestens in 40% dieser chronifizierten Falle besteht eine echte Therapieresistenz.

Duration of Absence from Work Is Related to Psychopathology, Personality, and Sociodemographic Variables in a Longitudinal Cohort.

Objective To examine, in a non-clinical sample, the association of psychopathology, personality, sociodemographic information, and psychosocial indicators of non-occupational functioning with the duration of absence from work in the past 12 months. Method A longitudinal community cohort of 591 adults from Switzerland was analyzed using multilevel ordered logistic regression, with several alternative models as robustness checks. Psychopathology was assessed using the total score (Global Severity Index) of the Symptom Check List-90 Revised. Results The highest psychopathology levels were associated with absences of 3 or more week duration, largely independently of age. Extraversion and being divorced, widowed or separated also corresponded with longer absences from work in some analyses. No effect of sex was found. Most effects tested were not statistically significant and estimates showed large uncertainty. Conclusion Although tentative, our results suggest a possible influence of psychopathology on work participation. It may thus be desirable in insurance-medical appraisals of work ability to include instruments for measuring psychopathology.

Einsatz von Dolmetschern im Rahmen der versicherungs-psychiatrischen Begutachtung

Limited knowledge of the German language represents a serious barrier for migrants into Switzerland to communicate successfully in a variety of health care settings, which may result not just in delayed access to treatment and poorer outcome, but also in difficulties judging eligibility for health and other social benefits. Especially when conducting disability and other occupational capacity evaluations, clinicians of all medical fields, but particularly psychiatrists, are required to obtain abundant information to allow them to perform a thorough mental health examination and to form a differentiated view of an evaluees work capacity. Within a clinical context different translation and interpreting strategies are in use, and each strategy has its advantages and disadvantages. This mini-review describes the legal and modal aspects as well as the clinical-practical implications of the use of such interpreting services during disability evaluations.