Introduction In heart transplant recipients, nonadherence is associated with higher risk of morbidity and mortality. Research Question Can a psychoeducational intervention enhance adherence to medical recommendations? Design We randomized 200 patients awaiting heart transplantation on the high urgency wait list to a manualized psychoeducational intervention or standard care. Follow-up continued to three years after transplantation. Primary endpoint was adherence to immunosuppressive medication, assessed at 3, 6, 12, 24, and 36 months posttransplant. Secondary endpoints were barriers to adherence during follow-up and clinical outcomes, including cardiac rejection within the first postoperative year and postoperative 3-year mortality. Results Fifty patients died before or within the first 3 months of transplantation. The primary endpoint was analyzed in 66 patients in the intervention group and 66 in the control group. Both study groups showed almost maximal adherence to immunosuppressive medication throughout follow-up, with no significant time x treatment interaction (P>0.99). Likewise, there was no significant time x treatment interaction (P=0.41) on barriers to adherence. The percentage of patients with International Society for Heart and Lung Transplantation standard grade 1 and 2 rejection was in the intervention and control groups 82.5% and 78.7%, respectively, and 8.8% and 13.1%, respectively, without significant differences between study groups (P=0.75). Considering all randomized and transplanted patients in the intervention group (N=85) and control group (N=87), postoperative 3-year mortality was 29.4% and 27.6%, respectively (P=0.82). Conclusions Adherence to immunosuppressive medication was high, even without a complex, manualized psychoeducational intervention. The intervention had no significant positive impact on cardiac rejection and mortality.

Background. Due to the relatively recent introduction of psychotherapy in South Korea and against the background of collectivist and Confucian values, it has been suggested that South Koreans harbor more negative attitudes towards psychotherapy compared to Germans and that the social acceptance of psychotherapy is lower. Methods. We compared the attitudes of 99 women from South Korea with 98 German women using the questionnaire on attitudes towards psychotherapeutic treatment (FEP). For the study of the South Korean women we translated the questionnaire into the Korean language. Results. The results of the psychometric analysis suggest that the Korean version of the FEP is of acceptable quality. South Korean women reported a significantly more negative attitude towards psychotherapy compared to German women. Furthermore, South Korean women anticipated a more skeptical social attitude towards psychotherapy compared to Germans. Conclusion. The presented results suggest the relevance of cultural imprinting in psychotherapy. They are discussed with respect to culture-specific self-concepts, concepts of disease and healing expectations and the increase of individualistic values in the Korean society.

Das Belastungserleben herzchirurgischer Patienten und psychische Komorbiditäten haben Einfluss auf das Outcome und den postoperativen Genesungsprozess. Eine entsprechende psychotherapeutische Mitversorgung sollte herzchirurgischen Patienten mit psychischen Komorbiditäten dringend angeboten werden. Das Berufsfeld der Psychokardiochirurgie gilt als wenig erkundet, wird bislang nur in einzelnen Kliniken umgesetzt und bedeutet neue Herausforderungen für den Psychotherapeuten. Dessen Rolle gilt es, zu reflektieren und im Klinikalltag sorgfältig umzusetzen. Die vorliegende Reflexion soll als persönlicher Einblick in dieses spannende Berufsfeld verstanden werden. Insgesamt muss die Versorgung psychischer Komorbiditäten in der Herzchirurgie in den diagnosebezogenen Fallgruppen (Diagnosis Related Groups, DRG) abrechnungsrelevant werden.

Introduction: Nonadherence may cause severe health problems in heart transplant (HTx) recipients. Research Questions: The present study aimed to investigate adherence to prescribed medication and recommended lifestyle habits in post-HTx patients and to assess associations between adherence, quality of life (QOL), and psychological well-being. Design: A questionnaire package was sent to all HTx patients from our clinic (n = 858) to answer questions anonymously on medication adherence, dietary recommendations (avoidance of raw animal products and ice cream), pet keeping (risk of zoonosis), anxiety and depression, QOL, and posttraumatic stress disorders. Results: Of the contacted patients, 524 (61%) responded and 505 fulfilled the inclusion criteria (age ≥18 years and ability to understand German). Of the study participants, 72.4% reported taking their medications very correctly, 72.2% stated consuming alcohol less often than once a week, 58.3% performed physical exercise at least once a week, one-third reported eating nonrecommended foods, 22.1% stated pet keeping, and 4.3% reported smoking. Adherence to prescribed medication was positively associated with age (P < .001) and mental QOL (P = .015) but was unrelated to eating nonrecommended foods (P > .05). Depressiveness correlated inversely with physical QOL (r = −0.232; P < .01) and mental QOL (r = −0.411; P < .01). Stress disorders and minor stressful events were reported by 7.8% and 46.6%, respectively. Stress disorders correlated inversely with mental QOL (r = −0.282; P < .01) and physical QOL (r = −0.422; P < .01). Discussion: Many HTx patients adhere to prescribed medications and health advice. Nevertheless, nonadherence is a problem, especially in younger HTx patients, indicating the need for a nonadherence crisis intervention program for long-term HTx patients.

Journal Article Causality for depression and psoriasis is a sex‐specific two‐way process Get access G. Schmid‐Ott G. Schmid‐Ott Berolina Klinik Bültestr. 21 32584 Loehne Germany Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 173, Issue 4, 1 October 2015, Page 891, https://doi.org/10.1111/bjd.14096 Published: 01 October 2015

Background. Psoriasis is associated with higher risk for depression and anxiety disorders. Yet the complex system linking disease symptoms with physical and mental outcomes is poorly understood.Objectives. The central aim of this study was to identify physical, psychological, and social factors that exacerbate or protect against the perception of symptoms of depression and anxiety among individuals starting in-patient treatment for psoriasis. Another aim was to investigate if improved clinical status of the psoriasis is associated with improved psychological and physical wellbeing one year after treatment.Materials and methods. In this follow-up study a sample of 381 psoriasis in-patients in Germany were questioned before starting treatment and one year after treatment (166 participants) using instruments to measure socioeconomic variables, perceived somatic severity, life quality (DLQI, SF-8), feelings of stigmatization (QES), and depression and anxiety (HADS-D). Coping (Trier Coping Scale) and pathological worry (PSWQ-PW) were also measured at the initial time point. Multiple regression analyses of variance for repeated measurements and of correlation were conducted.Results. Self-reported symptoms of anxiety and depression were higher than in normal populations. Perceived severity of physical symptoms was not correlated with depression or anxiety at the initial time point. The strongest predictors of depression and anxiety in our sample were measures of life quality. Life quality was predicted in a large part by stigmatization. Increased momentary symptom severity and increased perceived discomfort over time was not associated with increased perception of symptoms of depression.Conclusions. Our findings extend previous research on the importance of stigmatization for quality of life to the specific outcome of depression and anxiety. It confirms the desirability of early screening of psoriasis patients for depression and anxiety and initiating treatment by a qualified therapist.

established for each end-organ system, but not psychosocial criteria.To address this, we developed a new assessment tool: Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) to assess psychosocial risk factors for organ transplantation.SIPAT has shown to have high inter-rater reliability (Pearson's correlation coefficient ¼ 0.853) and high predictability of psychosocial outcomes (P o 0.001).Methods and Materials: Heart, lung, liver or kidney transplant candidates evaluated between 6/1/08-7/31/11 were assessed with SIPAT.We analyzed outcomes up to 1 year.Outcomes included: organ survival (primary); and patient survival, rejection, re-hospitalization, infection, non-compliance, psychiatric decompensation, failure of support, and albumin levels (secondary).Patients with SIPAT score of r 20 were compared with patients with SIPAT score of Z 21.Results: 217 patients were transplanted in the index period (46 heart, 58 lung, 58 liver and 55 kidney).181 of patients had SIPAT score of r 20; 36 had scores of 21-68.There was no significant difference in primary outcome, however patients with higher SIPAT scores had significantly higher rates of psychiatric decompensation (p¼0.006),non-adherence to treatment (p¼0.027), and had a higher frequency of medical hospitalizations (p¼ 0.057).Moreover, patients with higher SIPAT scores who were hospitalized had more hospitalizations per person (2.23) than those with lower SIPAT scores (1.32).Planned, further surveillance of these patients may yield more significant results.Conclusions: The SIPAT is a comprehensive screening tool designed to predict psychosocial and medical outcomes of organ transplant candidates.Results suggest SIPAT is a promising tool to standardize the evaluation process and identify risk for negative outcomes to which interventions may be applied during selection.

Introduction: Compliance (adherence) represents a multifactorial concept. Medication non-adherence is a major cause of organ dysfunction following heart transplantation. Beside a correct medicine taking a lifelong germ-poor food, smoking abstinence and restrictions belonging to domestic animal husbandry are expected. The prevalence varies considerably.

Introduction: Compliance (adherence) is a multifactor influenced concept. Lack of adherence can cause severe health problems in longtime Tx- Patients. Beside a reliable and correct medicament-intake patients are expected not to smoke, as well as to reduce their infection risk via contact to animals and germ-rich food. The prevalence varies considerably. Methods: In this cross-sectional study 858 Patients who underwent heart-transplantation were corresponded and asked to participate anonymous. 524 patients (61 %) replied to the questionnaires about medical-adherence (ITAS, ITBS, COMPAD), anxiousness and depressivity (HADS-D) and questions about nutrition and animal husbandry. Because the willingness to respond varied substantial between the forms, we used exclusion missing data pairwise. Descriptive Statistics and Chi-square tests were used to compute the results. Results: From 467 patients (54.4 %) over 18 years and completed ITAS, data could be computed.369 (79.2 %) male, and 97 (20.8 %) female participants could be included, one missing data. The men were on average 61.2 years old, women were significant younger (M = 53.5 years, p < .01). Age of the whole sample ranged from 18 to 90 years.456 participants (95.7 %) answered the question how many pills per day they have to take (Median = 14, range 1 - 77). Measured with ITAS 72.2 % of all participants showed very reliable, 14.4 % a reduced and 13.4 % an alarming unreliable immunosuppressant medicine intake.97 (20.3 %) patients had a job, most of them (62.9 %, N = 61) fulltime. Compared to not-working people patients with work were significant less compliant to medicine taking measured with ITAS (p = .004)Measured with HADS (cutoffs > 8, > 11), 46 patients (9.9 %) showed a slightly, 10.9 % (N = 51) a notable elevated score for depressivity and 14.1 % (N = 66) respective 12.4 % (N = 58) for anxiousness.71 persons (13.3 %) affirmed that they own at least one animal (multiple choice) with a lion's share for dogs (9 %, N = 41) and cats (4.4%, N = 21). To eat germ-rich food like raw meat or mould cheese daily or several a week indicated 9.2 % (raw meat, N = 44), and 8.4 % (mould cheese, N = 40) of the patients and up to 30 % stated for ‘occasionally’. 15 % of the patients (N = 71) indicated that they believed germ-rich food would not harm them. Conclusion: Although the adherence was ascertained only by self-assessment and a positive selection by the response rate has to be assumed, a medicine-referred non adherence of 27.8 % could be demonstrated. A worrisome infection risk related to germ-rich food and domestic animal keeping was confirmed. Interventions to increase post HTX adherence should refer to that purposefully.

Die offentliche Wahrnehmung der „y-Wort“-Berufsfelder Psychologie, Psychotherapie, Psychosomatik und Psychiatrie ist zum beachtlichen Teil irregeleitet und widerspruchlich. Einerseits werden diese Berufe von vielen als nicht wissenschaftlich begrundet und daher weniger effektiv als die rein somatisch-orientierte Medizin eingeschatzt. Andererseits bleibt die Nachfrage nach popularwissenschaftlich aufbereiteten Reportagen uber psychische Storungen nach wie vor sehr hoch. Trotz mitunter kompetenter Berichterstattung der Medien werden die „Y-Wort“-Berufe immer noch haufig stereotypisiert oder falsch charakterisiert. Irrtumliche Annahmen uber die menschliche Psyche sind immer noch weit verbreitet. Diese Tatsachen haben negative Auswirkungen fur Personen, die von einer psychischen Storung betroffen sind. Psychische Storungen werden oft ignoriert, bagatellisiert oder laienhaft behandelt. Die Inanspruchnahme einer psychiatrischen Behandlung wird tabuisiert. Dieser Artikel ist ein Pladoyer fur die Aufklarungsarbeit auf individueller und institutioneller Ebene.

Zielsetzung: Mit Hilfe dieses Forschungsprojektes sollte die Eignung des standardisierten Neurodermitisschulungskonzeptes zur Steigerung der Effizienz der Vorsorge und der Versorgung von Kindern und Jugendlichen mit atopischem Ekzem überprüft werden. Methode: Das Projekt wurde als randomisierte, klinisch kontrollierte, nationale, prospektive Multicenterstudie durchgeführt. Ergebnisse: Die Ergebnisse der Kosten-Nutzen-Anlayse sind nur sehr begrenzt aussagefähig. Die Ergebnisse der Kosten-Wirksamkeits-Studie zeigen hingegen auf, dass durch die Schulungen sowohl im Zeit- als auch im Gruppenvergleich positive Ergebnisse erzielt werden konnten. Schlussfolgerung: Schulungen für Kinder und Jugendliche mit atopischem Ekzem erzielen positive Effekte. Studien müssen jedoch, wenn sie repräsentative Ergebnisse erzielen sollen, eine längere Laufzeit ( mindestens drei Jahre ) haben.

Objectives: In this research project the feasibility of a standardised concept for neurodermatitis training courses is evaluated. Criteria are efficiency gains in prevention and provision effects for children and adolescents suffering from neurodermatitis.Methods: The project was based on a randomised, clinically controlled, national, prospective multi-centre study.Results: The results of the cost-benefit analysis are only marginally meaningful. However, the results of the cost-effectiveness analysis show that the training courses have positive effects with respect to different time and group constellations.Conclusion: Training courses for children and adolescents suffering from neurodermatitis had a positive effect in this study. Further studies are needed to collect the data necessary for making representative statements about the training effect. These studies need to be designed as longterm studies (at least three-year duration).

In der psychoneuroimmunologischen (PNI) Forschung herrscht Unklarheit darüber, inwieweit psychiatrische Komorbiditäten (Depressivität, chronische Erschöpfung) bei Brustkrebs durch erhöhte zelluläre Immunaktivität bedingt sind. Es wurden zwei integrative Einzelfallstudien an Patientinnen mit Brustkrebs in der Anamnese durchgeführt, um unter Alltagsbedingungen die Wechselwirkungen zwischen täglicher Stimmung, Erschöpfung und zellulärer Immunaktivität (Neopterin) zu analysieren. Beide Patientinnen (60a, 49a) sammelten 31 bzw. 28 Tage lang in 12-Stundenabständen ihren gesamten Harn zur Analyse von Neopterin (HPLC) und füllten Fragebögen u.a. zur Stimmung (EWL) und Erschöpfung (VAS, MFI) aus. Die Zeitreihen wurden anschließend modelliert (ARIMA, moving average smoothing) und die Wechselwirkungen zwischen den Variablen mittels Kreuzkorrelationen analysiert. Bei beiden Patientinnen ließ sich nachweisen, dass Stimmungsabfälle Neopterinanstiegen zeitlich signifikant vorausgingen, u.z. mit einer Verzögerung von 96 (lag4: -.697; p< 0.05) bzw. 132 Stunden (lag11: -.306; p< 0.05). Weiter zeigte sich, dass Neopterinanstiege Erschöpfungsanstiege triggerten, u.z. mit einer zeitlichen Latenz von 24 (lag1: +.491; p < 0.05) bzw. 60 Stunden (lag5: +.324; p < 0.05). Diese ersten Ergebnisse dokumentieren, dass mit einer angemessenen Methodik komplexe PNI-Zusammenhänge unter Alltagsbedingungen analysiert werden können. Weitere Studien müssen nun folgen, um das hier Gezeigte abzusichern.