Subjektive Krankheitskonzepte bei depressiven Störungen: Längsschnittstudie einer rehabilitativen Maßnahme

Depressive Störungen sind ein weit verbreitetes und oft chronisches Gesundheitsproblem mit erheblichem Leiden des Individuums und hohen Gesundheitskosten. Die subjektiven Wahrnehmungen einer solchen Erkrankung korrelieren mit deren Bewältigung. Dies kann insbesondere für depressive Störungen angenommen werden, da bei Depressionen die dysfunktionalen kognitiven Bewertungsprozesse sowohl ätiologisch relevant sind als auch die Krankheitsbewältigung ungünstig beeinflussen. Diese Studie hat zum Ziel, Zusammenhänge zwischen Dimensionen der Krankheitskonzepte von Patientinnen und Patienten, der depressiven Symptomatik und positivem Affekt zu untersuchen. Dazu wurden 60 Patientinnen und Patienten einer stationären psychosomatischen Rehabilitationsmaßnahme sowohl im Quer- als auch im Längsschnitt bis zur dreimonatigen Katamnese nach Entlassung befragt. Die Studienteilnehmer wurden weiterhin randomisiert einer Expressiven Schreib- oder einer Kontrollbedingung zugeteilt, um die Effekte dieser Minimalintervention als adjunkte Maßnahme zu untersuchen. Die Ergebnisse zeigen, dass die Wahrnehmung des zeitlichen Verlaufs und des Schwergrads der Depression sowie die emotionalen Repräsentationen der eigenen Erkrankung mit vermehrten depressiven Symptomen assoziiert sind. Im Längsschnitt zeigt sich, dass die Ausprägung kontrollbezogener subjektiver Krankheitskonzepte mit unterschiedlichen Verläufen der depressiven Symptomatik und des Wohlbefindens über einen Zeitraum von 3 Monaten nach Beendigung des stationären Aufenthalts im Zusammenhang stehen. Die subjektiv erlebte Kohärenz des Krankheitskonzepts war nur mit dem Wohlbefinden, aber nicht mit Depression verbunden. Expressives Schreiben konnte in dieser kleinen Gruppe zusätzlich zum stationären Aufenthalt zwar keine signifikanten Verbesserungen erzielen, jedoch zeigt sich, dass Personen mit einer stark ausgeprägten Neigung zu emotionalen Repräsentationen tendenziell mehr vom Schreiben profitieren und dass sich dieser Effekt über die Zeit zu verstärken scheint. Schlüsselwörter: Krankheitskonzept, Depression, Expressives Schreibe

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient's illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventiinfo:eu-repo/semantics/publishedVersio

Ambivalenz gegenüber emotionaler Expressivität: Überprüfung der Gütekriterien des AEQ-G18 in einer repräsentativen Stichprobe der deutschen Allgemeinbevölkerung

Objective: The present study evaluates a questionnaire on ambivalence over emotional expressiveness, the AEQ-G18 , , with regard to its statistical parameters, the influence of socio-demographic variables, and its interrelationship with depression and quality of life. Methods: A representative German sample (1009 participants from East Germany and 1034 participants from West Germany) completed the AEQ-G18 , , the depression screener DEP-2 , the Profile of Mood States POMS , the revised Beck Depression Inventory BDI , the short form of the Patient Health Questionnaire PHQ-9 and the SF-36 health survey questionnaire . Results: Our study was only partially able to confirm the two factors effect ambivalence and competence ambivalence postulated by Traue et al. , . Women scored somewhat higher on the scale effect ambivalence . Participants with a higher educational background exhibited less emotional ambivalence. Emotional ambivalence correlated positively with depression and reduced psychological state of health (depression, fatigue , and anger ), whereas it correlated negatively with health-related quality of life and positive attitude (vigor ). In addition to the scales of the AEQ-G18 , we developed a short form, the AEQ-G1 0, and provide normative data for the AEQ-G18 and the AEQ-G10 . Conclusion: This study presents normative data for two variations of a clinically relevant, valid, and time-efficient diagnostic instrument used for the evaluation of ambivalence over emotional expressiveness, the AEQ-G18 and its short form, the AEQ-G10 .Fragestellung: In der vorliegenden Untersuchung wurde ein Fragebogen zur Ambivalenz gegenüber emotionaler Expressivität, AEQ-G18 , bezüglich testtheoretischer Kennwerte, des Einflusses soziodemografischer Variablen und der Zusammenhänge mit Depressivität und Lebensqualität untersucht. Methoden: Der AEQ-G18 , , ein Depressions-Screener , DEP-2 , das Profile of Mood States, POMS , das revidierte Beck-Depressions-Inventar , BDI , die Kurzform des Gesundheitsfragebogens für Patienten, PHQ-9 und der Fragebogen zum Gesundheitszustand, SF-36 wurden einer repräsentativen deutschen Bevölkerungsstichprobe (1009 Befragte in Ostdeutschland und 1034 in Westdeutschland) vorgelegt. Ergebnisse: Die von Traue , postulierten zwei Faktoren Effekt- und Kompetenzambivalenz konnten in der vorliegenden Untersuchung nur teilweise bestätigt werden. Frauen gaben etwas höhere Werte auf der Skala Effektambivalenz an. Befragte mit höherer Bildung äußerten weniger emotionale Ambivalenz. Emotionale Ambivalenz korrelierte mit Depressivität und eingeschränktem psychischem Befinden (Niedergeschlagenheit, Müdigkeit und Missmut ) und stand in einem negativen Zusammenhang mit gesundheitsbezogener Lebensqualität und positiver Stimmung (Tatendrang ). Die Skalen des AEQ-G18 ergänzend wurde eine Kurzform, AEQ-G10 , entwickelt und Normwerte für den AEQ-G18 und AEQ-G10 zur Verfügung gestellt. Schlussfolgerungen: Mit der vorliegenden Untersuchung werden Normdaten für zwei Varianten (AEQ-G18 und die Kurzform AEQ-G10 ) eines klinisch relevanten, validen und zeitökonomischen diagnostischen Instruments zur Erfassung der Ambivalenz gegenüber emotionaler Expressivität präsentiert

[Ethic charter of the German Society for the Study of Pain (DGSS)]

The German Society for the Study of Pain has formed an interdisciplinary committee to answer urgent ethical questions on the diagnosis and treatment of pain and to give an ethical orientation on the care of pain and palliative patients. The treatment of pain is a fundamental objective of medicine. Competent and adequate relief of pain in all stages of life is a basic characteristic of a humane medicine oriented to the quality and meaning of life for people. However, there are substantial deficits in all areas, especially in the knowledge of physicians and patients, in training and further education, diagnosis and therapy. Freedom from pain is a substantial element of quality of life. A central duty of all physicians is an adequate diagnosis and treatment of acute pain and thereby the prophylaxis of chronic pain. If pain persists over a longer period of time, it loses the warning function and becomes taken for granted. Alterations, disabilities and limitations of the physical, psychic and social levels are the consequences. For these patients an interdisciplinary approach is necessary by which various medical disciplines, psychologists and physiotherapists are involved and all collaborate on the diagnosis and therapy of pain. All patients have the right to sufficient and individually tailored treatment of pain. Special attention must be paid to vulnerable patient groups, such as newborns, children and adolescents, as well as aged and mentally retarded patients. For cancer patients pain relief of their tumor pain is totally in the forefront. Indications of "unbearable pain" must not lead to resignation or even be seen as an argument for legalization of "death on request". The nursing of terminally ill patients necessitates a special measure not only of clinical, but also ethical competence, communication and multiprofessional collaboration. The modern options for palliative care are real alternatives to demands for legalization of "death on request". Physician-assisted suicide does not belong to the scope of functions of palliative medicine. The basic constitutional law makes an appropriate treatment of pain obligatory. Neglect of pain treatment fulfils the elements of criminal bodily harm. As a consequence, there is a legal right to a comprehensive pain diagnosis and a pain treatment corresponding to the appropriate standard. The state is obliged to provide the legal, social and financial prerequisites for an adequate treatment of pain. Continuous efforts in research are necessary to fill the existing gaps in our knowledge. The transfer between basic research and clinical application of pain therapy must be urgently improved. Of central importance for the German Pain Society are therefore: Improvement of training and further education in pain therapy. Chronic pain must be accepted and coded as an autonomous sickness. Graded structures for care of pain patients must be realized. Interdisciplinary structures of care must be made available to patients with chronic pain. Palliative medical care is a basic right of all terminally ill patients. Politics and health care providers must establish prerequisites for adequate pain diagnosis, pain therapy and palliative medicine

Multimodal prevention of first psychotic episode through N-acetyl-l-cysteine and integrated preventive psychological intervention in individuals clinically at high risk for psychosis: Protocol of a randomized, placebo-controlled, parallel-group trial.

AIM Meta-analyses indicate positive effects of both antipsychotic and cognitive-behavioural interventions in subjects clinically at high risk (CHR) for psychosis in terms of a delay or prevention of psychotic disorders. However, these effects have been limited regarding social functioning and the relative efficacy of both types of interventions remains unclear. Furthermore, neuroprotective substances seem to be a promising alternative agent in psychosis-prevention as they are associated with few and weak side-effects. METHODS In this multi-centre randomized controlled trial (RCT), we investigate the effects of two interventions on transition to psychosis and social functioning: (a) an integrated preventive psychological intervention (IPPI) including stress-/symptom-management and social-cognitive remediation; (b) N-acetyl-l-cysteine (NAC) as a pharmacological intervention with glutamatergic, neuroprotective and anti-inflammatory capabilities. RESULTS This is a double-blind, placebo-controlled RCT with regard to NAC and a single-blind RCT with regard to IPPI using a 2 × 2-factorial design to investigate the individual and combined preventive effects of both interventions. To this aim, a total of 200 CHR subjects will be randomized stratified by site to one of four conditions: (a) IPPI and NAC; (b) IPPI and Placebo; (c) NAC and psychological stress management; (d) Placebo and psychological stress management. Interventions are delivered over 26 weeks with a follow-up period of 12 months. CONCLUSION This paper reports on the rationale and protocol of an indicated prevention trial to detect the most effective and tolerable interventions with regard to transition to psychosis as well as improvements in social functioning, and to evaluate the synergistic effects of these interventions