Wolfram Keller

Effect of psychotherapy and relaxation on the psychosocial and somatic course of Crohn's disease: main results of the German Prospective Multicenter Psychotherapy Treatment study on Crohn's Disease.

OBJECTIVE Few studies have been published on the influence of psychotherapy on the physical and psychosocial course of Crohns disease (CD). METHODS The present study, a prospective, randomized multicenter investigation conducted with 108 of 488 consecutive CD patients, was designed to investigate the influence of short-term psychodynamic therapy and relaxation in addition to a standardized glucocorticoid therapy on the somatic course of the disease as well as on patient psychosocial status. Based on the same standardized somatic treatment, the psychotherapy and control groups were compared after a 1-year treatment period and a follow-up of another year with regard to somatic course and psychosocial situation. RESULTS A total of 81 (75%) of 108 randomized patients completed the psychosocial follow-up. The comparison between the therapy groups after 1 year showed no significant differences in the four main target criteria of psychosocial status (depression, anxiety, psychosocial-communicative status and health-related quality of life). The mean Becks Depression Inventory (BDI) score at admission was 12.3 in the psychotherapy group and 8.7 in the control group. At the 1-year follow-up, the scores for depression have been 7.8 (psychotherapy group) and 7.8 (control group). In the 2-year follow-up, 84 patients were classified into four groups on the basis of somatic course; 23% of the control group and 30% of the psychotherapy group showed episode-free courses, 29% and 17% respectively underwent surgery due to failure of immunosuppressive or medical therapy, and a further subranking showed no significant differences between the two groups (P=.125). At the 1-year follow-up, the scores for depression of patients with an active episode respective remission were 14.6 vs. 5.8. From the patients point of view, at the end of the 2-year follow-up, the overall subjective evaluation of the effectiveness of psychotherapy was positive. CONCLUSION The patients included showed no psychosocial disturbances of clinical relevance. Although a tendency toward fewer surgical interventions, fewer relapses and reduction of depression was noted, the analysis was unable to demonstrate any benefit from psychosocial intervention on hypothesized parameters of psychosocial status and somatic course. Further studies should be performed to identify patient subgroups that may benefit from psychosocial intervention.

Structural change as a predictor of long-term follow-up outcome

Abstract Based on data from psychoanalytic long-term psychotherapies, the predictive value of three measures of pre–post change for retrospective patient assessments of outcome at 1-year and 3-year follow-up was investigated. Pre–post changes were measured using the Global Severity Index (GSI), the Inventory of Interpersonal Problems (IIP) total score, and the Heidelberg Structural Change Scale (HSCS). In line with psychoanalytic theory, it was assumed that structural changes cause especially persistent changes and would, therefore, be most suitable to predict the follow-up criterion. This expectation was confirmed: Pre–post changes in GSI and IIP were only weakly associated with assessments at 1-year follow-up and not at all with assessments at 3-year follow-up. In contrast, correlations between changes in HSCS and outcome assessments were highly significant at both occasions.

Stationäre tiefenpsychologisch orientierte Psychotherapie bei depressiven Störungen (STOP-D) - Erste Befunde einer naturalistischen, multizentrischen Wirksamkeitsstudie

OBJECTIVES While the general effectiveness of psychodynamic psychotherapy in both outpatient and inpatient treatment has been proven, few studies document the effectiveness of clinical inpatient treatment of depression through psychodynamic psychotherapy. METHODS This paper presents first results of a naturalistic multicenter intervention study. Included were female inpatients suffering from depressive symptoms who had been admitted to 15 psychodynamically oriented psychosomatic hospital units (N = 487). The mean duration of treatment was 61.8 days. Data were acquired at admission (T1) and discharge (T2). RESULTS Our findings support previous evidence and show that psychodynamically oriented inpatient psychotherapy of depressive disorders is efficient. High pre-post effect sizes were documented in all psychometric instruments used (BDI, HAM-D, SCL-90-R, BSS, GAF). Initial subgroup comparisons reveal that the benefits for patients with comorbid personality disorder are significantly lower than for depressed patients without comorbid personality disorder. CONCLUSION Psychodynamic inpatient psychotherapy, as practiced under naturalistic conditions, is an effective treatment of depression. Predictors of therapeutic effects within different therapeutic settings, however, remain unclear. The sustainability of the therapeutic effects found and their impact on psychodynamic relevant constructs have still to be proven.

Patterns of interpersonal problems and their improvement in depressive and anxious patients treated with psychoanalytic therapy

Interpersonal problems were studied in 121 patients treated with psychoanalytic therapy using the Inventory of Interpersonal Problems. Four characteristic subtypes were identified, which differed in the quality and flexibility of their interpersonal behavior. Independent of the predominant type of interpersonal problems, the psychotherapy treatment led to strong decreases in interpersonal distress and increases in interpersonal differentiation. Psychoanalytic therapy was highly effective for all identified interpersonal subtypes and seems to help patients achieve more satisfactory relationships.

Wirksamkeit und Inanspruchnahme von Krankenkassenleistungen bei Langzeitanalysen: Ergebnisse einer empirischen Follow-up-Studie zur Effektivität der (Jungianischen) Psychoanalyse und Psychotherapie

Leider besteht für diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den Textanfang zur Verfügung. Jungianer stehen nicht in der Tradition empirischer Psychotherapieforschung. Sie fühlen sich eher der Individualität ihrer Patienten verpflichtet und sind daher gegenüber den Ergebnissen der empirischen Psychotherapieforschung mit dem Anspruch nach Generalisierbarkeit meist skeptisch eingestellt. Mit dieser skeptischen Einstellung stehen die Jungianer allerdings nicht alleine. Auch anderere psychoanalytische Schulrichtungen sind nur zögerlich und unter dem wachsenden Druck der Gesundheitsadministration bereit, die Qualität ihrer Behandlungen empirisch zu überprüfen.

What Happens After Treatment: Can Structural Change be a Predictor of Long-Term Outcome?

The first systematic follow-up study of therapeutic results was delivered by the Berlin Psychoanalytic Institute and reported by Fenichel [1]. This study set a precedent that many psychoanalysts were to follow in subsequent years [2–4] (for a review see [5]). At times, the work of these analysts had far-reaching social impacts; the studies Duhrssen [6] performed at the Berlin Central Institute for Psychogenic Illnesses led to the inclusion of psychodynamic (PD) and psychoanalytic (PA) treatments among the forms of therapy covered by health insurance in Germany. From the available literature, it is clear that the PA community has cared about the issue of the long-term effects of treatment from early on.

Prädiktoren für die medizinische Inanspruchnahme am Beispiel von Patienten mit der Diagnose Morbus Crohn

ZusammenfassungZiel:In der Studie sollten Prädiktoren für eine medizinische Inanspruchnahme in Form von Arbeitsunfähigkeits-(AU-) und Krankenhaus-(KH-)Tagen am Beispiel von Patienten mit der Diagnose Morbus Crohn identifiziert werden.Patienten und Methodik:Vor diesem Hintergrund erfolgte die Analyse von 499 Patienten, welche über einen Zeitraum von 2 Jahren beobachtet wurden und aus denen eine Stichprobe von 87 Patienten gezogen wurde. Die Inanspruchnahme wurde anhand von AU- und KH-Tagen operationalisiert. Als mögliche Prädiktoren einer Inanspruchnahme fungierten soziodemographische, psychische und krankheitsspezifische Variablen.Ergebnisse:Im Rahmen einer linearen Regressionsanalyse erwiesen sich mit den AU-Tagen als abhängige Variable das Geschlecht (b = 43,01; p = 0,032) und die Depressivität (b = 2,949; p = 0,014) als statistisch signifikante, unabhängige Einflussvariablen (R2 = 0,189). Im Regressionsmodell mit der abhängigen Variable KH-Tage waren das Geschlecht (b = 19,863; p = 0,006) und das Alter (b = 0,785; p = 0,029) statistisch signifikant (R2 = 0,114). Für die somatische Krankheitsschwere ließ sich kein Zusammenhang mit der Inanspruchnahme in Form von KH- bzw. AU-Tagen nachweisen.Schlussfolgerung:Psychosoziale Faktoren wie Depressivität, Geschlecht und Alter haben demnach einen geringen, aber messbaren Einfluss auf die medizinische Inanspruchnahme bei Morbus Crohn. Eine stärkere Berücksichtigung dieser Charakteristika in der klinischen Praxis würde nicht nur die individuelle Lebensqualität verbessern, sondern zugleich die Inanspruchnahme gesundheitlicher Leistungen reduzieren.AbstractPurpose:The objective of the study was to identify predictors of health-care utilization in Crohns disease.Patients and Methods:Therefore, data of 499 patients was collected over a 2-year period. A sample of 87 patients was taken and analyzed. Health-care utilization was measured as work disability days and hospital bed days. Sociodemographic, mental as well as somatic variables were used as possible predictors of health-care utilization.Results:In a linear regression model with work disability days, the variables gender (b = 43.01; p = 0.032) and depressiveness (b = 2.949; p = 0.014) turned out to be significant (R2 = 0.189). In a linear regression model with hospital bed days, the variables gender (b = 19.863; p = 0.006) and age (b = 0.785; p = 0.029) proved to be significant (R2 = 0.114). No significant result was found for somatic variables such as severity of disease.Conclusion:Psychosocial variables such as depressiveness, gender and age have, therefore, a low but measurable impact on health-care utilization of patients with Crohns disease. Increased consideration of these variables in clinical practice would not only improve the quality of life of these patients but also reduce health-care utilization.

Prädiktoren für die medizinische Inanspruchnahme am Beispiel von Patienten mit der Diagnose Morbus Crohn@@@Predictors of Health-Care Utilization of Patients with Crohn's Disease. Results of a Prospective Randomized Multicenter Trial: Ergebnisse einer multizentrischen, prospektiv-randomisierten Studie

ZusammenfassungZiel:In der Studie sollten Prädiktoren für eine medizinische Inanspruchnahme in Form von Arbeitsunfähigkeits-(AU-) und Krankenhaus-(KH-)Tagen am Beispiel von Patienten mit der Diagnose Morbus Crohn identifiziert werden.Patienten und Methodik:Vor diesem Hintergrund erfolgte die Analyse von 499 Patienten, welche über einen Zeitraum von 2 Jahren beobachtet wurden und aus denen eine Stichprobe von 87 Patienten gezogen wurde. Die Inanspruchnahme wurde anhand von AU- und KH-Tagen operationalisiert. Als mögliche Prädiktoren einer Inanspruchnahme fungierten soziodemographische, psychische und krankheitsspezifische Variablen.Ergebnisse:Im Rahmen einer linearen Regressionsanalyse erwiesen sich mit den AU-Tagen als abhängige Variable das Geschlecht (b = 43,01; p = 0,032) und die Depressivität (b = 2,949; p = 0,014) als statistisch signifikante, unabhängige Einflussvariablen (R2 = 0,189). Im Regressionsmodell mit der abhängigen Variable KH-Tage waren das Geschlecht (b = 19,863; p = 0,006) und das Alter (b = 0,785; p = 0,029) statistisch signifikant (R2 = 0,114). Für die somatische Krankheitsschwere ließ sich kein Zusammenhang mit der Inanspruchnahme in Form von KH- bzw. AU-Tagen nachweisen.Schlussfolgerung:Psychosoziale Faktoren wie Depressivität, Geschlecht und Alter haben demnach einen geringen, aber messbaren Einfluss auf die medizinische Inanspruchnahme bei Morbus Crohn. Eine stärkere Berücksichtigung dieser Charakteristika in der klinischen Praxis würde nicht nur die individuelle Lebensqualität verbessern, sondern zugleich die Inanspruchnahme gesundheitlicher Leistungen reduzieren.AbstractPurpose:The objective of the study was to identify predictors of health-care utilization in Crohns disease.Patients and Methods:Therefore, data of 499 patients was collected over a 2-year period. A sample of 87 patients was taken and analyzed. Health-care utilization was measured as work disability days and hospital bed days. Sociodemographic, mental as well as somatic variables were used as possible predictors of health-care utilization.Results:In a linear regression model with work disability days, the variables gender (b = 43.01; p = 0.032) and depressiveness (b = 2.949; p = 0.014) turned out to be significant (R2 = 0.189). In a linear regression model with hospital bed days, the variables gender (b = 19.863; p = 0.006) and age (b = 0.785; p = 0.029) proved to be significant (R2 = 0.114). No significant result was found for somatic variables such as severity of disease.Conclusion:Psychosocial variables such as depressiveness, gender and age have, therefore, a low but measurable impact on health-care utilization of patients with Crohns disease. Increased consideration of these variables in clinical practice would not only improve the quality of life of these patients but also reduce health-care utilization.