RESUMEN
BACKGROUND: Despite of the undisputed impact of education quality on becoming a specialist in psychiatry and psychotherapist, systematic studies in this field do not exist in Germany, apart from the evaluation of practical education by the medical councils. MATERIALS AND METHODS: The Akademie-OWL, an education union of psychiatric clinics in the East Westphalia region of Germany, has provided 12-item questionnaire-based routine evaluations of theoretical education seminars since 2009. Seminars are held by consultants of psychiatry and psychotherapy within six separate weeks over a period of four years. All lecturers receive feedback from the evaluation. The results of this ongoing evaluation are presented using a typical example and in an aggregated format as a time series on the basis of one global item. RESULTS: The data show that (1) the full range of a five-point Likert scale is used by the candidates, (2) psychiatric competences of the lecturers are more positively evaluated than their didactic competences, (3) neither within the four-years period of psychiatric education nor between different generations of candidates are systematic changes of evaluation results observed, and (4) minor to moderate differences of evaluation were observed between the different thematic fields of psychiatry and psychotherapy. DISCUSSION: These results indicate the need of more systematic education research on establishing valid and reliable specific instruments as well as the need of systematic training of didactic competences of teaching consultants.
Asunto(s)
Educación Médica Continua , Psiquiatría/educación , Psicoterapia/educación , Facultades de Medicina , Especialización , Competencia Clínica , Curriculum , Docentes Médicos , Alemania , Humanos , Encuestas y CuestionariosRESUMEN
Objective: Evaluation of a project offering low-threshold anonymous counseling services jointly by mental health services and child and youth services to support children in families with mentally ill parents Methods: Evaluating performance data and completed questionnaires returned by parents included in the project. Results: Between 2011-2014, 150 families received up to 10 sessions of family-oriented counseling. The survey results indicate a high level of satisfaction with the services of the cooperation project. The vast majority of respondents said that they would recommend this service to others or would themselves take advantage of the services again. Conclusion: A collaboration of service providers from psychiatry and child and youth welfare department resulting in continuous availability of counseling with a common family medical perspective represents a forward-looking model for families with a mentally ill parent.
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Protección a la Infancia/estadística & datos numéricos , Hijo de Padres Discapacitados/estadística & datos numéricos , Terapia Familiar/organización & administración , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Grupo de Atención al Paciente/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Adolescente , Adulto , Niño , Protección a la Infancia/psicología , Hijo de Padres Discapacitados/psicología , Preescolar , Consejo Dirigido/estadística & datos numéricos , Femenino , Alemania/epidemiología , Humanos , Lactante , Recién Nacido , Colaboración Intersectorial , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Enfermos Mentales/psicología , Persona de Mediana Edad , Apoyo Social , Poblaciones Vulnerables/psicología , Adulto JovenRESUMEN
BACKGROUND: The aim of the present study was to develop a questionnaire to assess the perception and evaluation of admission to a psychiatric hospital from a patient's perspective (QAE-P). MATERIAL AND METHODS: Based on existing literature and a preparatory pilot study, a questionnaire consisting of 126 items was developed, and 708 inpatients based in 6 psychiatry and psychotherapy clinics were asked to answer the items. The resulting data were split into two data sets. In the first subset, exploratory factor analysis was used to help determine the number of scales and provide the basis for item reduction. The resulting questionnaire was validated by means of confirmatory factor analyses (CFA) in the second data subset. RESULTS: The resulting questionnaire comprises 33 items in 7 scales, which assess: (1) helpful, positive relations with staff members; (2) offering of medical explanations to patients and their involvement in treatment planning; (3) evaluation of rooms and clinical environment; (4) dissatisfaction with doctors and staff members; (5) evaluation of handling of ward rules by staff; (6) perception of ward atmosphere; and (7) negative perception of other inpatients. The plausibility of this factorial structure was supported by the results of the CFA. CONCLUSIONS: The QAE-P is a short and feasible questionnaire that meets the criteria of classic test theory and assesses different dimensions of the patient's experience of admission to a psychiatric hospital.
Asunto(s)
Internamiento Obligatorio del Enfermo Mental , Hospitales Psiquiátricos , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Admisión del Paciente , Satisfacción del Paciente , Servicio de Psiquiatría en Hospital , Encuestas y Cuestionarios , Adulto , Anciano , Coerción , Conducta Cooperativa , Análisis Factorial , Femenino , Alemania , Humanos , Comunicación Interdisciplinaria , Masculino , Trastornos de la Memoria/diagnóstico , Trastornos de la Memoria/psicología , Persona de Mediana Edad , Trastornos del Humor/psicología , Trastornos del Humor/rehabilitación , Proyectos Piloto , Relaciones Profesional-Paciente , Psicometría/estadística & datos numéricos , Trastornos Psicóticos/psicología , Trastornos Psicóticos/rehabilitación , Reproducibilidad de los Resultados , Medio Social , Percepción Social , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/rehabilitaciónRESUMEN
BACKGROUND: The purpose of this study was to investigate associations of patient's scores in the newly constructed questionnaire on patients' psychiatric admission experiences (QAE-P) and individual, institutional, and situational factors. PATIENTS AND METHODS: Data of 708 patients and 6 participating hospitals were analyzed. Patient characteristics between clinics were compared and univariate as well as multivariate analyses were applied to examine associations of QAE-P total score and individual as well as institutional variables (t tests, univariate and multivariate analyses of variance, correlation analyses, and effect sizes of significant associations). RESULTS: There was little variance of patient characteristics between hospitals. Multiple univariate associations with small to medium effect sizes were found between total QAE-P scores and demographic and clinical variables of the patients, institutional variables, and (non-independent) situational views of the patients. After multivariate analyses were applied, these associations remained significant for gender, age, diagnosis, the personal decision to be admitted, and for previous planning of admission with the outpatient doctor. The hospital variables shown to be associated with total QAE-P scores were open versus closed ward, disorder-specific organization of the ward, and the number of other patients being treated under the German Mental Health Act. CONCLUSION: Principally the QAE-P seems to be a suitable instrument of quality management. A number of factors were identified that show associations with the subjective evaluation of admission as reported by the patients. Some of these variables are within the control of the clinical management.
Asunto(s)
Internamiento Obligatorio del Enfermo Mental , Hospitales Psiquiátricos , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Admisión del Paciente , Satisfacción del Paciente , Encuestas y Cuestionarios , Adulto , Análisis Factorial , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Relaciones Profesional-Paciente , Psicometría/estadística & datos numéricos , Reproducibilidad de los Resultados , Medio Social , Percepción SocialRESUMEN
BACKGROUND: Self-ratings of psychotic experiences might be biased by depressive symptoms. METHOD: Data from a large naturalistic multicentre trial on depressed inpatients (n=488) who were assessed on a biweekly basis until discharge were analyzed. Self-rated psychotic symptoms as assessed with the 90-Item Symptom Checklist (SCL-90) were correlated with the SCL-90 total score, the SCL-90 depression score, the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale 21 item (HAMD-21) total score, the Montgomery Åsberg Depression Rating Scale (MADRS) total score and the clinician-rated paranoid-hallucinatory score of the Association for Methodology and Documentation in Psychiatry (AMDP) scale. RESULTS: At discharge the SCL-90 psychosis score correlated highest with the SCL-90 depression score (0.78, P<0.001) and with the BDI total score (0.64, P<0.001). Moderate correlations were found for the MADRS (0.34, P<0.001), HAMD (0.37, P<0.001) and AMDP depression score (0.33, P<0.001). Only a weak correlation was found between the SCL-90 psychosis score and the AMDP paranoid-hallucinatory syndrome score (0.15, P<0.001). Linear regression showed that change in self-rated psychotic symptoms over the treatment course was best explained by a change in the SCL-90 depression score (P<0.001). The change in clinician-rated AMDP paranoid-hallucinatory score had lesser influence (P=0.02). CONCLUSIONS: In depressed patients self-rated psychotic symptoms correlate poorly with clinician-rated psychotic symptoms. Caution is warranted when interpreting results from epidemiological surveys using self-rated psychotic symptom questionnaires as indicators of psychotic symptoms. Depressive symptoms which are highly prevalent in the general population might influence such self-ratings.
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Depresión/complicaciones , Trastorno Depresivo/complicaciones , Pacientes Internos/psicología , Trastornos Psicóticos/diagnóstico , Adulto , Lista de Verificación , Depresión/psicología , Trastorno Depresivo/psicología , Autoevaluación Diagnóstica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Psicometría , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/psicologíaRESUMEN
INTRODUCTION: Assessment of depression severity is of key importance, since several clinical guidelines recommend choice of treatment dependent on the depression severity grade. Using different tools to assess baseline severity may result in different outcomes. METHODS: This paper describes the results of a multicentre, naturalistic study investigating the relationship between depression symptom severity (using 4 different measures of symptom severity) and clinical outcome among patients hospitalised for depression (N=1 014). Moreover, the impact of differences between methods of measuring depression severity has been investigated. Statistical analyses (univariate measurements, logistic regression models) were conducted to detect coherences and differences between the various methods of severity categorisation. RESULTS: Results revealed different associations between outcome and classification methods. Response or remission rates varied if baseline severity was assessed by different instruments. Moreover, the number of responders increased with higher baseline severity grades of depression, whereas the number of remitters decreased. Additional analyses dependent on outcome criteria using continuous instead of categorical data revealed similar results. DISCUSSION: Baseline severity may be only one of many other important clinical variables that mediate clinical outcome, but it is surely an important one deserving further research and consideration.
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Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Factores Sexuales , Resultado del TratamientoRESUMEN
Personality is one of most frequently investigated fields in depression research and, despite changes in research paradigms, has not lost its relevance. Numerous results concerning the conceptualization of conspicuous personality traits, their aetiopathogenetic significance, and their effect on treatment and course have contributed to a better understanding of depression. Genetics and neurobiology provide new incentives for research in this field. We present an overview of aspects relevant to personality research in depression including personality types, personality traits, temperament factors, and personality disorders. Especially results on personality factors' effect on treatment and course of depression, integrating these results with different personality models in depression, and their consequences to treatment and further research of personality traits in depression are discussed.
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Depresión/diagnóstico , Depresión/psicología , Modelos Psicológicos , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/psicología , Personalidad , Temperamento , HumanosRESUMEN
The relevance of family interactions in the course of affective disorders has been well described. In contrast to the situation regarding schizophrenic disorders, there are few systematic concepts for involvement of the relatives of patients with affective disorders in treatment. The goal of this study was the development and evaluation of a standardised psychoeducational treatment programme. We determined the number and characteristics of relatives accepting the offer of such a group. Relatives of almost half of 55 patients with major depression and a bipolar disorder participated in the group. Relatives of male patients were more likely to take part than relatives of female patients. Relatives of patients with a bipolar disorder were more likely to take part than relatives of patients with unipolar depression. The patients whose relatives attended the group showed a more favourable understanding of the illness and more knowledge about affective disorders, but on the other hand, felt themselves to be more strongly criticised by their relatives and had less social support than the other patients. These results emphasise the importance of differential family-focused treatment modalities in affective disorders.
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Trastorno Bipolar/terapia , Cuidadores/educación , Trastorno Depresivo Mayor/terapia , Terapia Familiar , Psicoterapia de Grupo , Adaptación Psicológica , Adulto , Anciano , Trastorno Bipolar/psicología , Cuidadores/psicología , Costo de Enfermedad , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Desarrollo de Programa , Factores Sexuales , Apoyo Social , Resultado del TratamientoRESUMEN
The extent to which personality characteristics predict the course of severe depression has been controversially discussed. In a sample of 50 depressed inpatients, the significance of personality characteristics for the prediction of relapse was studied prospectively over 2 years. More than half of the patients studied suffered relapses within this period. Well-known predictors such as the number of previous episodes were confirmed. The personality characteristics studied showed different predictive effects at 1- and 2-year follow-up. Neurosis proved predictive of the 1-year course and outcome but not the 2-year course. In the 2nd year of follow-up, a melancholic personality structure was associated with favourable outcome. This personality type therefore seems to be more appropriate as a predictor of long-term outcome. Comparison with predictive factors described earlier showed that in this study, personality traits influence outcome independently and were not confused by other predictors. Implications for relapse prevention and psychotherapeutic management are discussed.
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Trastorno Depresivo Mayor/diagnóstico , Trastornos de la Personalidad/diagnóstico , Inventario de Personalidad/estadística & datos numéricos , Adulto , Comorbilidad , Trastorno Depresivo Mayor/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/psicología , Recurrencia , Factores de RiesgoRESUMEN
The construct of expressed emotion is regarded as one of the most important predictors of the course of schizophrenia and has also proven to be a predictor of the course of depressive disorders, psychosomatic disorders and physical illness. Despite its clinical significance, the utility of the EE-construct has been limited since measurement by interview is time-consuming, and to date only applicable to psychotic illness. Questionnaires as a practicable alternative to the structured interview are also mostly applicable solely to psychotic disorders. One exception is the Family Emotional Involvement and Criticism Scale (FEICS, Shields et al.). This questionnaire allows a general assessment of EE and thus a practical application of EE to the general area of family research. In a sample of n = 202 patients, the German version of this instrument proved to be reliable in our research. The two-factor structure of the original American version was replicated. We found good correlation between the measured factors, and clinical and other diagnostic markers particular to family pathology. This questionnaire is therefore a brief, reliable and valid instrument for measuring EE in many disorders.
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Emoción Expresada/fisiología , Familia/psicología , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana EdadRESUMEN
This study assessed family perception patterns of interpersonal behavior in families with a daughter diagnosed with an eating disorder 6 years after treatment that used a prospective design. Family perception patterns of patients found to have a poor outcome at followup (n = 15) were compared with patients with a good outcome (n = 23), as well as a control group (n = 36). Using the system of multiple level observation of groups (SYMLOG), all 238 family members evaluated themselves and each other. The index patients with a poor outcome perceived themselves as friendlier and more positive than they were perceived by their families. In comparison to parents of daughters with a good outcome and the control group, parents of daughters in the poor outcome group perceived themselves to be less friendly than their partners perceived them to be. A rigid polarization of the perception of the index patient by family members and a discrepancy in this perception between the index patient and the rest of the family were found to be indicative of a poor prognosis. Implications for treatment based on family perception patterns of interpersonal behavior are discussed.
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Conducta , Familia/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Relaciones Interpersonales , Adolescente , Adulto , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Factores de TiempoRESUMEN
In the Heidelberg study about psychoanalytic therapy with children and adolescents 133 cases have been studied in a naturalistic design. Up to now results were published on the basis of assessments of experts only. This follow-up study has investigated the stability of therapy outcomes from the perspectives of different raters. For that outcome has been rated five years after the end of treatment by experts, parents and children themselves. Good outcomes have been stabile and have shown even after five years. Single variables showed further improvement in the time of follow-up, for example the social communicative impairment with parents. Thus the high rate of successful longterm psychoanalytic therapies with children and adolescents could be confirmed from different rater perspectives.
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Trastornos Mentales/terapia , Terapia Psicoanalítica/métodos , Adolescente , Niño , Trastornos de la Conducta Infantil/terapia , Depresión/terapia , Femenino , Estudios de Seguimiento , Alemania , Humanos , Masculino , Trastornos Mentales/psicología , Escalas de Valoración Psiquiátrica , Psicología del Adolescente , Psicología Infantil , Autoevaluación (Psicología) , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Since the 1960s the association of stressful life events and depression seemed to be firmly established. However, a few recent studies did not confirm those earlier findings. One of the reasons discussed for the inconsistencies was the sampling of milder depressed neurotic out-patients in the earlier studies vs. more severely ill endogenous type in-patients in recent studies. METHODS: This investigation was carried out with 50 consecutively admitted in-patients with endogenous depression according to ICD 9 and unipolar major depression according to DSM-III-R as ascertained by SCID. The control sample consisted of 26 healthy volunteers. Life events and chronic distressing life conditions were recorded with the Munich Interview for the Assessment of Life Events and Conditions (MEL) every 3 months over a period of 2 years along with psychopathological symptoms and recurrencies. Hence the design was prospective in the sense that life events were recorded for one 3-month cross-section, the depressive reaction for the subsequent one. BDI scores taken at the respective cross section were used to control for depressive bias of the subjective part of the patient's life event evaluation. RESULTS: Three months prior to the index hospitalization patients were more often affected by life events and conditions than controls. The number of stressful conditions prior to the index hospitalization indicated the time to relapse after discharge. Controls showed more desirable positive conditions than patients. Relapse patients suffered more often stressful life events and conditions than non-relapsers 3 months prior to their relapse. Multivariate analysis indicates that the cumulative number of life events within the 2-year course is the best predictor of the BDI score at the end of the follow-up period. LIMITATIONS: Since the subjective component of life event assessment by MEL displayed a higher impact on the course of depression than the objective part of the assessment, confounding of subjective ratings, attributional styles, and depressive symptoms may be a problem although controlled for in this study. CONCLUSION: The results support the importance of stressful life events and chronic distressing conditions for the 2-year course and outcome of major depression in an in-patient sample. Since the overall consistency of significant results was more pronounced in the subjective than in the objective part of the MEL the results fit best a circular pathogenetic model of interactions between life events, their individual evaluation by the patient, and depressive symptoms.
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Trastorno Depresivo Mayor/etiología , Acontecimientos que Cambian la Vida , Estrés Psicológico/psicología , Adulto , Estudios Transversales , Trastorno Depresivo Mayor/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Recurrencia , Índice de Severidad de la EnfermedadRESUMEN
A number of studies has shown a significant relationship between life events/life conditions and depression. However, there is only a small number of studies investigating the effect of life events/life conditions in patients with severe depression from the endogenous subtype. The results are inconsistent. The present study examines the significance of the patients' life events/life conditions for the two year outcome of the illness in a prospective study with assessments every three months. Patients are compared to healthy controls with regard to the period three months prior to the admission to the hospital at the index episode. The results confirm the importance of life events and life conditions for the long term outcome of depressed patients with endogenous subtype respectively severe major depression in-patients. Relapsers show considerably more undesirable life conditions than non-relapsers three to six months prior to their relapse. Depressed patients indicate significantly more undesirable life events and life conditions and fewer desirable life conditions in comparison to the control group for the time span three months prior to their hospitalization. Clinical implications are discussed.
Asunto(s)
Trastorno Depresivo Mayor/psicología , Pacientes Internos , Acontecimientos que Cambian la Vida , Adulto , Estudios de Casos y Controles , Trastorno Depresivo Mayor/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Recurrencia , Factores de TiempoRESUMEN
Long-term course of depression appears to be clearly correlated to marital quality and quality of the relationship with spouses. Aim of the present study is the replication of results, indicating that expressed emotion (EE) is an important factor in prediction of relapse in depression. Additionally, the correlation between EE shown by spouses and the severeness of depressive symptomatology as well as the importance of martial quality as seen by patients for relapse are investigated. Results of our study indicate that spouses EE does not predict relapse, and status of EE does not correlate with the extent of depressive symptoms. However, patient self ratings of satisfaction with marital relationship and of perceived criticism are related to relapse frequency. Additionally, discrepant ratings of marital satisfaction given by spouses predict relapse to some extent. Implications for research in affective disorders and clinical practice are discussed.
Asunto(s)
Trastorno Depresivo/psicología , Emoción Expresada , Matrimonio/psicología , Adulto , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente , Determinación de la Personalidad , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Esposos/psicologíaRESUMEN
By means of an aggregated variables design the domains of 'psychopathology', 'personality', and 'social interaction' were weighted according to their impact on the 2-year course of 50 patients with unipolar major depression. Preindex course ranked highest, asthenic personality second. Variables of social interaction disappeared in the second-order logistic regression. These findings fit in well with the recent literature. They are interpreted in terms of habituation processes and residual personality changes which lower the vulnerability threshold for relapse and unfavorable course. As a consequence of this conclusion early relapse prevention would be most important.
Asunto(s)
Trastorno Depresivo/psicología , Relaciones Familiares , Matrimonio/psicología , Trastornos de la Personalidad/psicología , Adulto , Trastorno Depresivo/diagnóstico , Femenino , Humanos , MMPI , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/diagnóstico , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Recurrencia , Factores de TiempoRESUMEN
The long-term course of major depressive disorder is often accompanied by relapses or chronicity. Since psychosocial factors have been shown to be important predictors for the long-term outcome, psychotherapy along with drug therapy belongs to the standard methods of treatment. In spite of the effectiveness of psychotherapy, only some of the inpatients are treated with outpatient psychotherapy after hospital discharge. Within the framework of the Heidelberg depression study the authors examined what kind of, how many and for how long endogenously depressed patients sought out-patient psychotherapy after an inpatient treatment in a two-year follow-up. During the follow-up one half of patients were treated with outpatient psychotherapy. They were found to be younger, had suffered from more previous episodes, and their personality was more disturbed than those who had not undergone psychotherapy. The Expressed Emotion index did not make any further difference, whereas certain aspects of partnership quality did. The distinction between the two groups of patients is discussed regarding possible selection processes by treatment indication. It is pointed out that research on synergistic cooperation between members of the mental health services is highly desirable.