Stationäre Behandlung depressiver Erkrankungen wohnortnah oder wohnortfern: Gibt es Unterschiede im Therapieergebnis?

Background: Advantages and disadvantages of inpatient treatment for mental disorders in facilities located either close to or distant from the patients' homes have been controversially discussed since the Psychiatry Enquiry. However, the question whether the distance between residence and clinic influences the treatment outcome has so far only been examined in substance-dependent patients in residential medical rehabilitation. Therefore, in the present study, we aimed to investigate potential effects of the distance between residence and clinic on the treatment outcome in depressive patients. Patients and Methods: For this purpose, routine data of 1,959 clinically depressed inpatients were analyzed. Using the Patient Health Questionnaire, depression, anxiety, and somatization were assessed at admission, discharge, and the 6-month follow-up to analyze the treatment outcome. Results: The findings demonstrate that the distance between the residence and the treatment facility does not moderate depressive, anxious, and somatoform symptom changes during and after treatment. Moreover, the distance between clinic and residence and the symptom improvement from admission until follow-up do not correlate significantly. Conclusions: Hence, there is no empirical evidence showing that the distance between the residence and the treatment facility influences the treatment outcome. Therefore, future research should focus on the impact of specific treatment qualities close to or far away from home, like the facility's degree of specialization and the implementation of individualized aftercare

Fear conditioning and stimulus generalization in patients with social anxiety disorder

Although overgeneralization seems to be a hallmark of several anxiety disorders, this until now has not been investigated in social anxiety disorder (SAD). Therefore, we examined fear generalization in 26 SAD patients and 29 healthy controls (HC) using two faces as conditioned stimuli (CS+, CS-), and a loud scream and a fearful face as unconditioned stimulus (US). Generalization was tested by presenting both CS and four morphs of the two faces (generalization stimuli [GSs]), while ratings, heart rate (HR) and skin conductance responses (SCR) were recorded. Results revealed that SAD patients rated all stimuli as less pleasant and more arousing compared to HC. Moreover, ratings and SCR indicated that both groups generalized their acquired fear from the CS+ to GSs. Remarkably, only SAD patients showed generalization in HR responses (fear bradycardia). Overall, SAD seems not to be characterized by strong overgeneralization but discrepancies in fear responses to both conditioned and generalized threat stimuli. (C) 2016 Elsevier Ltd. All rights reserved

Cognitive Change and Relaxation as Key Mechanisms of Treatment Outcome in Chronic Pain: Evidence From Routine Care

Despite effective treatment approaches within the cognitive behavioral framework general treatment effects for chronic pain are rather small to very small. Translation from efficacy trials to naturalistic settings is questionable. There is an urgent need to improve the effectiveness of well-established treatments, such as cognitive-behavior therapy (CBT) and the investigation of mechanisms of change is a promising opportunity. We performed secondary data analysis from routine data of 1,440 chronic pain patients. Patients received CBT in a multidisciplinary setting in two inpatient clinics. Effect sizes and reliable change indices were computed for pain-related disability and depression. The associations between changes in the use of different pain coping skills (cognitive restructuring, activity despite pain, relaxation techniques and mental distraction) and changes in clinical outcomes were analyzed in structural equation models. Pre–post effect sizes range from g = 0.47 (disability) to g = 0.89 (depression). Changes in the use of cognitive restructuring, relaxation and to a lesser degree mental distraction were associated with changes in disability and depression. Effects from randomized trials can be translated to naturalistic settings. The results complement experimental research on mechanisms of change in the treatment of chronic pain and indicate an important role of cognitive change and relaxation as mechanisms of change. Our findings cautiously suggest that clinicians should optimize these processes in chronic pain patients to reduce their physical and emotional disability

Deutsche S3-Leitlinie Behandlung von Angststörungen

Die deutsche S3-Leitline zur Behandlung von Angststörungen (Panikstörung/Agoraphobie, generalisierte Angststörung, soziale Phobie, spezifische Phobie) bei Erwachsenen wurde unter Beratung und Moderation durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) von einem Gremium erstellt, das 20 Fachverbände und andere Organisationen aus den Bereichen Psychotherapie, Psychologie, psychosomatische Medizin, Psychiatrie und Allgemeinmedizin sowie Patientenvertreter und Selbsthilfeorganisationen umfasst. Die Empfehlungen dieser Leitlinie basieren auf einer Sichtung der Evidenz der verfügbaren randomisierten klinischen Studien zu Angststörungen nach ICD/DSM und einer Synthese der Empfehlungen anderer Leitlinien