Unions in Germany: Searching to regain the initiative

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Cognitive behavior therapy in panic disorder and comorbid major depression - A naturalistic study

Background: There is a lack of evidence about the effectiveness of cognitive behavior therapies (CBT) in settings of routine clinical care as well as in the treatment of panic and comorbid disorders. Methods: We investigated a group-oriented CBT approach for 80 patients with panic disorder including 35 patients with current comorbid major depression. Assessments took place 6 months before treatment, at the beginning and end of treatment, and 1 year later. Structured interviews and multiple clinical self-rating scales were used. Results: Panic patients with comorbid major depression showed higher anxiety-specific and nonspecific pathology. The most striking benefits were in reducing avoidance behavior, while improvements concerning catastrophic beliefs were smaller, but still significant. For most self-rating scale results, patients with and without comorbid depression improved to a comparable degree. However, the end-state functioning of patients with panic disorder and current comorbid depression at admission is significantly lower than for patients with panic disorder alone, Conclusions: The results point to the necessity to develop and improve treatment approaches for patients with comorbidity of panic disorder and current major depression. Copyright (C) 2000 S.Karger AG, Basel

Predictors of course and outcome in hypochondriasis after cognitive-behavioral treatment

Background. Predictors of treatment outcome were evaluated in a clinical sample suffering from hypochondriasis. Methods: The sample consisted of 96 patients with hypochondriacal disorder according to DSM-IV or high syndrome scores on the Illness Attitude Scales (IAS) or Whiteley Index (WI). After intense inpatient cognitive-behavioral treatment (CBT), 60% of the patients were classified as responders because of substantial improvements or recovery from hypochondriacal symptomatology. Results: Non-responders were characterized by a higher degree of pre-treatment hypochondriasis, more somatization symptoms and general psychopathology (SCL-90R), more dysfunctional cognitions related to bodily functioning, higher levels of psychosocial impairments, and more utilization of the health care system as indicated by the number of hospital days and costs for inpatient treatments and medication. No predictive value was found for sociodemographic variables, comorbidity with other mental disorders and chronicity. Multiple linear regression showed that pre-treatment variables significantly predicted IAS scores at post-treatment (R-2 = 0.59), changes during treatment (0.10), IAS scores at follow-up two years later (0.41) and changes between baseline and follow-up (0.25). Conclusions: The results demonstrate the relevance of various psychopathological variables and health care utilization as important indicators for outcome and further course of clinical hypochondriasis. Copyright (C) 2002 S. Karger AG, Basel

Opening of an interface flaw in a layered elastic half-plane under compressive loading

A static analysis is given of the problem of an elastic layer perfectly bonded, except for a frictionless interface crack, to a dissimilar elastic half-plane. The free surface of the layer is loaded by a finite pressure distribution directly over the crack. The problem is formulated using the two dimensional linear elasticity equations. Using Fourier transforms, the governing equations are converted to a pair of coupled singular integral equations. The integral equations are reduced to a set of simultaneous algebraic equations by expanding the unknown functions in a series of Jacobi polynomials and then evaluating the singular Cauchy-type integrals. The resulting equations are found to be ill-conditioned and, consequently, are solved in the least-squares sense. Results from the analysis show that, under a normal pressure distribution on the free surface of the layer and depending on the combination of geometric and material parameters, the ends of the crack can open. The resulting stresses at the crack-tips are singular, implying that crack growth is possible. The extent of the opening and the crack-top stress intensity factors depend on the width of the pressure distribution zone, the layer thickness, and the relative material properties of the layer and half-plane

Selbsthilfeorganisationen und -gruppen in der Verhaltensmedizin: Übersicht und Beschreibung

Background: Over the past years self-help organizations have become an essential part of prevention and rehabilitation in German health care. It was the aim of our enquiry to inform experts and interested persons about the most important self-help organizations (SHO) and self-help groups (SHG) of different fields in behavioral medicine. Methods: 70 SHO and SHG of different fields in behavioral medicine were selected dealing with allergy and asthma, congenital disorders, relatives of patients with psychic disorders, anxiety disorders, chronic pain disorders, eating disorders, diseases of the musculoskeletal system, diseases of the gastrointestinal tract and incontinence, skin diseases, hearing and speech disorders, life crises, disorders pertaining to the nervous system, personality disorders and psychic problems, abuse, or obsessive-compulsive disorders. The selected SHO and SHG received a structured questionnaire including questions regarding (1) address, (2) means of contact, (3) group of interest, (4) tasks and aims, (5) provision, (6) structure of organizations, and (7) comments. Results: 90% of SHO replied, 56 SHO sent back the questionnaire completely answered, 5 institutions sent material of information instead, and 30 included both questionnaire and information material. The data clearly show the extensive support SHO might offer to sufferers. Conclusions: This report provides an informative overview of SHO. It might help to support the already existing cooperation between experts and SHO in this field

Das Strukturierte Interview für Anorektische und Bulimische Ess-Störungen nach DSM-IV und ICD-10 zur Expertenbeurteilung (SIAB-EX) und dazugehöriger Fragebogen zur Selbsteinschätzung (SIAB-S)

Background: The Structured Inventory for Anorexic and Bulimic Syndromes according to DSM-IV and ICD-10 consists of the Structured Expert Interview for Anorexic and Bulimic Syndromes (SIAB-EX) and the corresponding self report questionnaire (SIAB-S). These instruments assess symptoms of eating disorders and other symptoms often found in eating-disordered individuals (e.g. anxieties, symptoms of OCD, depression, substance abuse and impairment of sexuality and social integration). Thus, parallel forms for self-report and expert rating are available. Separate factor analyses resulted in very similar factor structures for self-report and interview as well as for both time points assessed: current (last 3 months before the interview) and past (time from puberty up to 3 months before the interview). Both assessments can be used for diagnosing eating disorders according to DSM-IV and ICD-10 and a total score can be computed. Method: Test criteria were assessed using a sample of 377 inpatients treated for an eating disorder. For the expert interview, SIAB-EX data were collected in a community sample of 202 young women without eating disorders. Results: Test criteria were satisfying or better. Interrater reliability (kappa) for the expert interview SIAB-EX was 0,81 (current) and 0,85 (past). Sensitivity, specificity, and positive predictive value were very good for the SIAB-EX (ppv = 0.91 lifetime) and the SIAB-S (ppv = 0.98 lifetime). Means for SIAB-EX and SIAB-S for the inpatient sample are reported. For the expert interview SIAB-EX norms for 202 young non-eating disordered women are given. Conclusion: The expert interview SIAB-EX can be seen as a `gold standard' for the assessment of eating disorders. The SIAB-EX is available in German, English, Italian and Spanish

Veränderung von Persönlichkeitsmerkmalen im Verlauf einer stationären Therapie

Background: The Freiburger Personality Inventory (FPI-R) is a well established and proven instrument for the assessment of personality traits. Although personality is conceived as a stable trait, clinical experience indicates that impressive changes are found on personality scales during intensive treatment. Method A large sample of inpatients which were treated with cognitive-behavioral therapy for bulimia nervosa, tinnitus or anxiety disorder was evaluated concerning the question which items of the FPI-R were answered differently or identically before and after intensive therapy. Results: It could be found that items which cover aspects that are central to the therapy more often show changing answers. The use of conditional form and indefinite frequency adjuncts in the formulation of items evidently allowed a more differentiated weighting of pros and cons at the end of therapy. Effects of regression to the mean could be excluded as an explanation by empirical data. Conclusion: It can be concluded that changes in answering items before and after intensive therapy can be explained as specific effects of therapy