Yesim Erim

Muttersprachliche psychiatrische Behandlung

Parallel zur Einrichtung vonMigrantenambulanzen in psychiatrischen Institutionen und von spezialisierten stationären Behandlungssettings für Migranten in psychosomatischen Kliniken entstand Mitte der 90er-Jahre der Begriff „muttersprachliche Behandlung“. Gemeint ist der Einsatz von bilingualen Mitarbeitern mit psychiatrischer und psychotherapeutischer Fachkompetenz in der Versorgung von Migranten. Meistens handelt es sich um Kinder von Gastarbeitern, die neben ihrer beruflichen auch ihre kulturelle und sprachliche Kompetenz in ihre Tätigkeit einbringen. Die muttersprachliche Behandlung ist eine Antwort der psychiatrischen und psychosomatischen Institutionen auf die besonderen Bedürfnisse der zunehmenden Population mit Migrationshintergrund. In der Literatur finden wir 2 ähnliche Begriffe: Kirmayer [1] definiert den kulturellen Konsiliardienst (Cultural consultation service) und Tantam [2] beschreibt die „ethnische Passung“ (=ethnic matching), die Behandlung der Migranten durch Therapeuten aus der gleichen ethnischen Gruppe. Unter die Aufgaben des kulturellen Konsiliardienstes subsumiert Kirmayer eine ausführliche Erstdiagnostik durch einen muttersprachlichen Experten bei Zuweisung von Patienten mit kulturellen oder sprachlichen Besonderheiten. Dabei sollen die für die Diagnostik und Therapie relevanten kulturellen Besonderheiten benannt werden. Auch die Beratung von autochthonen (einheimischen) Therapeuten bei schwierigem Behandlungsverlauf und die Untersuchung kulturspezifischer Begebenheiten, die den Therapieverlauf beeinflussen, gehören zum Aufgabenspektrum eines solchen Konsiliardienstes.

Somatization among persons with Turkish origin: Results of the pretest of the German National Cohort Study

OBJECTIVE Despite the emerging need to examine mental health of immigrants, there are no investigations designed to analyze representative samples in Germany. The aim of the present study was to explore the severity of somatic symptoms/somatization among a sample of considerable size consisting of persons with Turkish origin. We studied whether somatization was associated with sociodemographic and migration-related characteristics. METHODS This examination was part of a pretest for a large national epidemiological cohort study in Germany. We applied the somatization (PHQ-15) and the depression module (PHQ-9) from the Patient Health Questionnaire in a subsample of 335 Turkish immigrants. We analyzed the distribution of the sum score. Differences in degree of somatization in relation to relevant socio-demographic (gender) and migrant-related characteristics (generation of immigration) were tested with analysis of covariance (ANCOVA), controlling for age. A multiple linear regression analysis was also conducted. RESULTS Women had significantly higher age-adjusted mean scores than men (M=10.4, SD=6.3 vs. M=8.1, SD=6.3; F=10.467, p=0.001), a significant effect of age was also found (F=4.853, p=0.028). First generation immigrants had a higher age-adjusted mean number of symptoms in relation to the second generation immigrants (M=10.0, SD=6.5 vs. M=7.4, SD=7.0; F=6.042, p=0.014), the effect of age was not significant (F=0.466, p=0.495). Multiple regression analysis revealed that lower severity of somatization was associated with lower numbers of diagnosed physical illnesses (β=0.271, p<0.001) and better language proficiency (β=0.197, p=0.003, explained variance: 15.6%). CONCLUSIONS The degree of somatization among Turkish immigrants in Germany is associated with gender and generation of immigration.

Insecure attachment style and cumulative traumatic life events in patients with somatoform pain disorder: A cross-sectional study

OBJECTIVE Current models assume somatoform pain disorder (SPD) to be the result of a complex interaction between bio- and psychosocial factors, but the etiology is still not well understood. This study aimed to investigate the distribution of attachment style and the frequency of traumatic life events, especially childhood adversities, in patients with SPD compared to healthy controls. METHODS We compared 65 patients with SPD (confirmed by Structured Clinical Interview, SCID-I) to 65 age- and gender-matched healthy controls. The following questionnaires were employed: Relationship Scale Questionnaire (RSQ), Essen Trauma Inventory (ETI), Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-15). A logistic regression analysis was used to identify the association between SPD and psychological factors. RESULTS Insecure attachment was significantly more prevalent (60%) in patients with SPD compared to healthy subjects (14%; p<0.001). Overall, 70.4% of patients with SPD reported three or more traumatic events in their life, compared with healthy subjects who reported predominantly one (40%). Patients with SPD scored significantly higher in all CTQ subscales compared to the healthy controls. The factor most strongly related with SPD was the insecure attachment style (OR=11.20, 95% CI: 1.32-94.86). Other significant predictive factors were depression (OR=3.35, 95% CI: 1.84-6.11) and number of traumatic events (OR=2.04, 95% CI: 1.06-3.92). Insecure attachment, depression symptoms and the number of traumatic events explained 86.2% of the variance. CONCLUSIONS The high predictive value of insecure attachment style and cumulative traumatic events emphasize their importance as risk factors of SPD.

Integration of Clinical Examination, Self-Report, and Hair Ethyl Glucuronide Analysis for Evaluation of Patients With Alcoholic Liver Disease Prior to Liver Transplantation.

Context: A large proportion of liver transplants (LTXs) are performed due to alcoholic liver disease (ALD) in the final stage of organ insufficiency. In order to list patients for LTX, transplant centers commonly require 6 months abstinence from alcohol. However, significant differences have been reported between alcohol intake as indicated by self-report and biochemical markers of alcohol. Objective: In the present study, the usefulness of ethyl glucuronide analysis in hair (hETG) was examined during the evaluation procedure before listing patients with ALD for an LTX. Design: Cross-sectional survey. Setting: Psychosomatic evaluation. Patients: Seventy patients with ALD prior to listing for an LTX. Interventions: According to clinical assessment before listing patients with ALD (n = 233) for an LTX, hETG analysis was only performed in the patients who were assumed to deny or underreport their alcohol consumption (n = 70). Main Outcome Measures: The analysis of hETG by liquid chromatography–mass spectrometry, clinical interview. Results: By hETG analyses, 27 (38.6%) of the 70 patients tested positive for ongoing alcohol consumption. Conclusions: Selective use of hETG based on the clinical interview rather than widespread screening is a possible way to detect excessive alcohol consumption in patients with ALD in the transplant setting. The primary evaluation of a patient’s situation in its entirety should remain the superordinate standard procedure. An interdisciplinary approach to transplant candidates with an ALD is asked for.

Health-related quality of life and sense of coherence among Polish immigrants in Germany and indigenous Poles

Immigrants are faced with several impediments in the host country that may affect their quality of life (QoL), but little is known about the impact of these stressors as well as about the protective role of sense of coherence (SoC) in the context of Polish immigration to Germany. Health Related QoL (Short Form Health Survey SF-36) and SoC (Sense of Coherence Scale SOC-29) were assessed in a total sample consisting of 511 participants aged between 18 and 84 years (260 Polish immigrants in Germany and 251 indigenous Poles). Polish immigrants reported a significantly lower mental and physical health-related QoL than the German norm population, but they were comparable to native Poles. This result remained the same when the model was adjusted for age but physical health status was better for immigrants compared with indigenous Poles. Both groups scored significantly lower for SoC than Germans, but did not differ from each other. The main differences concerning the examined variables were with respect to the German norm population and are putatively shaped by culture.

Standardized Evaluation of Candidates Before Liver Transplantation With the Transplant Evaluation Rating Scale

BACKGROUND The Transplant Evaluation Rating Scale (TERS) was developed to provide a standardized evaluation of the psychosocial functioning of patients, before transplantation. Yet, the first 2 items of the TERS are based on psychiatric diagnoses referring to Diagnostic and Statistical Manual (DSM)-III-R, which leads to a duplication of disorder-specific and symptom-specific contents, that makes it complex to rate. Moreover, the TERS has not been updated to DSM revisions and DSM is not used for the official clinical routine documentation in several European countries. OBJECTIVE The objective of this study was, therefore, to investigate the psychometric properties of a diagnoses-corrected version of the TERS (items 1 and 2 omitted). METHODS In 85 patients awaiting liver transplantation, the discrimination capacities, predictive value, convergent validity, and interrater reliability of the original version (TERS10) and the diagnoses-corrected version (TERS8) were analyzed. RESULTS In both versions, patients with psychiatric diagnoses (69.4%) exhibited significantly higher TERS mean values than patients without psychiatric disorders. This also held for patients who were temporarily not found eligible for transplantation in the psychosocial evaluation (25.9%) compared with patients who were eligible for listing for transplantation. Furthermore, the area under the curve was >0.90 for both versions and a cutoff of 32.25 is suggested for TERS8 (sensitivity of 90.9% and specificity of 87.3%). CONCLUSIONS Our results substantiate good psychometric properties of the revised (diagnoses corrected) TERS, which is of great benefit for standardized psychosocial evaluation before liver transplantation. Further, validation of TERS8 and its cutoff in other samples of (liver) transplantation patients is needed.

Media exposure and posttraumatic stress disorder: review and implications for psychotherapy

The posttraumatic stress disorder (PTSD) is conceptualised as a psychological reaction upon traumatic events of distinct threat. Especially after the terrorists´ attacks of September 11th 2001, the scientific evaluation of the impact of media coverage of war and terrorism on mental functions of healthy individuals and the question whether the exposure of previously traumatised individuals to media coverage of war and disasters may act as a trigger for a trauma re-activation has begun in the US. There are positive associations between media exposure and the presence of PTSD symptoms. The amount (length) of media consumption appears to be a crucial variable to consider. Psychotherapists are asked to broach the issue of a careful and self-protecting handling of media coverage during therapy.

Iranische und deutsche Patienten in einer psychiatrischen Großstadtpraxis: Gibt es Unterschiede in Bezug auf Häufigkeit und Schweregrad psychischer Störungen?

OBJECTIVE Frequency and severity of mental illness in patient samples of two culturally different origins. METHODS Employment of the structured interview (Mini-DIPS) and self-assessment questionnaires on depression (BDI-II) and general psychiatric symptom load (SCL-90-R) as well as posttraumatic symptoms (ETI) and sense of coherence (SOC-29) in 55 Iranian and 51 German patients of a psychiatric practice. RESULTS Iranian patients show higher symptom load, but also higher resilience. CONCLUSION The higher burden of symptoms in Iranians can be attributed to traumatic experiences before migration on the one hand and is associated with insufficient language proficiency on the other hand.

Differential Diagnoses of Food-Related Gastrointestinal Symptoms in Patients with Anorexia Nervosa and Bulimia Nervosa: A Review of Literature.

OBJECTIVES The present review investigates the prevalence and medical causes of food-related gastrointestinal symptoms in eating disorder (ED) patients and recommends a diagnostic algorithm based on the current literature. METHODS A literature search was conducted, which included publications from January 2000 until January 2017 Results: Over 90% of ED patients suffer from food-related symptoms. There is no evidence for a higher prevalence of immunological or structural gastrointestinal disorders in ED patients compared to the healthy population. Most food-related symptoms in ED patients are likely to be functional. CONCLUSIONS Diagnostic work-up of food-related symptoms in ED patients needs to be based on clinical history. Only if timing and quality of symptoms point towards a disorder independent from the ED is a comprehensive diagnostic work-up necessary.

Psychosocial Variables Associated with Immunosuppressive Medication Non-Adherence after Renal Transplantation

Introduction Non-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors. Methods In 330 adult renal transplant recipients (≥12 months posttransplantation), health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated. Results 33.6% of the patients admitted to be partially non-adherent. Non-adherence was associated with younger age, poorer social support, lower mental, but higher physical health-related quality of life. There was no association with depression and anxiety. However, high proportions of clinically relevant depression and anxiety symptoms were apparent in both adherent and non-adherent patients. Conclusion In the posttransplant follow-up, kidney recipients with lower perceived social support, lower mental and higher physical health-related quality of life, and younger age can be regarded as a risk group for immunosuppressive medication non-adherence. In follow-up contacts with kidney transplant patients, physicians may pay attention to these factors. Furthermore, psychosocial interventions to optimize immunosuppressive medication adherence can be designed on the basis of this information, especially including subjectively perceived physical health-related quality of life and fostering social support seems to be of importance.