57 results on '"M, Berger"'
Search Results
2. [Psychotherapy of depressive disorders : Procedures, evidence and perspectives].
- Author
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Meister R, Jansen A, Berger M, Baumeister H, Bschor T, Harfst T, Hautzinger M, Kriston L, Kühner C, Schauenburg H, Schorr SG, Schneider F, and Härter M
- Subjects
- Antidepressive Agents therapeutic use, Cognitive Behavioral Therapy methods, Combined Modality Therapy, Depressive Disorder diagnosis, Depressive Disorder psychology, Diagnosis, Differential, Follow-Up Studies, Humans, Interpersonal Relations, Psychotherapy, Psychodynamic methods, Quality of Life psychology, Self Concept, Social Adjustment, Depressive Disorder therapy, Evidence-Based Medicine, Psychotherapy methods
- Abstract
Background: Depressive disorders are associated with a high burden of suffering and significantly reduce the well-being and the self-esteem of affected patients. Psychotherapy is one of the main treatment options for depressive disorders., Objective: The aim of this article is to present the current evidence for antidepressive psychotherapeutic treatments., Material and Methods: During the revision of the German S3- and National Disease Management Guideline (NDMG) on unipolar depression in 2015, a comprehensive and systematic evidence search was conducted. The results of this search along with a systematic update are summarized., Results: The most intensively investigated psychotherapeutic method is cognitive behavioral therapy (CBT), which proved to be effective in many trials. Evidence also exists for psychodynamic psychotherapy and interpersonal therapy (IPT), followed by systemic therapy and client-centered psychotherapy; however, the evidence is less robust., Conclusion: Psychotherapy alone or in combination with pharmacotherapy was shown to be an effective treatment option. Psychotherapy represents a key element in the treatment of depressive disorders.
- Published
- 2018
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3. [Psychotherapy of depressive disorders: Evidence in chronic depression and comorbidities].
- Author
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Härter M, Jansen A, Berger M, Baumeister H, Bschor T, Harfst T, Hautzinger M, Kriston L, Kühner C, Schauenburg H, Schorr SG, Schneider F, and Meister R
- Subjects
- Chronic Disease, Comorbidity, Depressive Disorder diagnosis, Depressive Disorder psychology, Depressive Disorder, Treatment-Resistant diagnosis, Depressive Disorder, Treatment-Resistant psychology, Depressive Disorder, Treatment-Resistant therapy, Guideline Adherence, Humans, Mental Disorders diagnosis, Mental Disorders psychology, Mental Disorders therapy, Outcome and Process Assessment, Health Care, Depressive Disorder therapy, Evidence-Based Medicine, Psychotherapy methods
- Abstract
Background: Psychotherapy has been shown to be an effective treatment option for depressive disorders; however, its effectiveness varies depending on patient and therapist characteristics and the individual form of the depressive disorder., Objectives: The aim of this article is to present the current evidence for psychotherapeutic antidepressive treatments for patients with chronic and treatment-resistant depression as well as for patients with mental and somatic comorbidities., Material and Methods: During the revision of the currently valid German S3- and National Disease Management Guideline (NDMG) on unipolar depression published in 2015, a comprehensive and systematic evidence search including psychotherapy for specific patient groups was conducted. The results of this search along with a systematic update are summarized., Results: Psychotherapy has been shown to be effective in reducing depressive symptoms in patients suffering from chronic and treatment-resistant depression and in patients with mental and somatic comorbidities. The evidence is insufficient particularly for patients with mental comorbidities., Conclusion: Based on the current evidence and clinical expertise the NDMG recommends psychotherapy alone or in combination with pharmacotherapy to treat most of these depressive patient groups. Evidence gaps were identified, which highlight the need for further research.
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- 2018
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4. [Erratum to: Guideline-oriented inpatient psychiatric psychotherapeutic/psychosomatic treatment of anxiety disorders. How many personnel are need?]
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Bandelow B, Lueken U, Wolff J, Godemann F, Wolff-Menzler C, Deckert J, Ströhle A, Beutel M, Wiltink J, Domschke K, and Berger M
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- 2017
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5. [Overcoming treatment resistance in chronic depression : The role of inpatient psychotherapy].
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Köhler S, Sterzer P, Normann C, Berger M, and Brakemeier EL
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- Evidence-Based Medicine, Germany, Humans, Cognitive Behavioral Therapy methods, Depressive Disorder, Major psychology, Depressive Disorder, Major therapy, Hospitalization
- Abstract
Background: Chronic depression poses a particular challenge for the psychiatric and psychotherapeutic care system. Owing to high rates of psychiatric comorbidities and multiple pharmacological and psychotherapeutic treatment resistance, novel treatment strategies are urgently required., Aim: In this article, we describe the clinical characteristics of chronic and treatment-resistant depression and review the pharmacological and psychotherapeutic treatment options currently available. We focus on the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), the first specific psychotherapy approach to chronic depression. Finally, we discuss the role of psychotherapeutic inpatient programs and stepped care concepts in chronic and treatment-resistant depression.
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- 2016
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6. [Guideline-adherent inpatient psychiatric psychotherapeutic treatment of borderline personality disorder : Normative definition of personnel requirements].
- Author
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Bohus M, Schmahl C, Herpertz SC, Lieb K, Berger M, Roepke S, Heinz A, Gallinat J, and Lyssenko L
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- Borderline Personality Disorder epidemiology, Germany epidemiology, Guideline Adherence organization & administration, Humans, Models, Organizational, Models, Statistical, Needs Assessment, Personnel Staffing and Scheduling standards, Workload standards, Workload statistics & numerical data, Borderline Personality Disorder therapy, Inpatients statistics & numerical data, Personnel Staffing and Scheduling statistics & numerical data, Practice Guidelines as Topic, Psychotherapy standards, Psychotherapy statistics & numerical data
- Abstract
Background: Borderline personality disorders (BPD) are severe mental diseases which place high pressure on the psychiatric healthcare system. Nowadays, well-tested, disorder-specific treatment concepts are available also for inpatient treatment in Germany. These show very good and long-term improvements in the psychopathology as well as posttreatment social participation; however, prerequisites for the implementation of these evidence-based inpatient psychotherapy programs are well-trained treatment teams and appropriate financing of resource expenditure., Objective: The aim was to formulate a definition of normative needs for treatment duration and intensity for a guideline-conform, empirically proven and effective inpatient treatment of borderline personality disorder as well as the derived personnel requirements in comparison to the currently available resources within the framework of the Psychiatry Personnel Act (Psych-PV)., Material and Methods: The resource requirements were established based on evaluated hospital ward models, the recommendations of the S2 guidelines and the criteria of specialist societies and compared with the personnel stipulations according to the Psych-PV., Results: The results for a normatively established treatment program showed a pronounced deficit in the financing of the evaluated resource requirements, even when the stipulations laid down in the Psych-PV were implemented to 100 %., Discussion: Disorder-specific inpatient treatment programs for borderline personality disorder have been scientifically proven to be highly effective; however, resource analyses show that the personnel requirements necessary for effective implementation of these programs are much higher than those allocated by the funding according to the Pysch-PV. The current underfunding leads to inadequate treatment outcomes with high readmission rates and as a result high direct and indirect costs of illness.
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- 2016
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7. [Guideline-adherent inpatient psychiatric psychotherapeutic treatment of obsessive-compulsive disorder : Normative definition of personnel requirements].
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Klein JP, Zurowski B, Wolff J, Godemann F, Herpertz SC, Berger M, Heuft G, and Hohagen F
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- Germany epidemiology, Guideline Adherence organization & administration, Humans, Models, Organizational, Models, Statistical, Needs Assessment, Obsessive-Compulsive Disorder epidemiology, Personnel Staffing and Scheduling standards, Workload standards, Workload statistics & numerical data, Inpatients statistics & numerical data, Obsessive-Compulsive Disorder therapy, Personnel Staffing and Scheduling statistics & numerical data, Practice Guidelines as Topic, Psychotherapy standards, Psychotherapy statistics & numerical data
- Abstract
Background: Guideline-oriented inpatient psychiatric and psychotherapeutic treatment of patients with obsessive-compulsive disorder (OCD) is an important part of the care available for these patients. It may not be adequately reflected in the current personnel resources available according to the German psychiatry personnel regulation (Psych-PV)., Objectives: The goal of this work was to assess the personnel resources necessary for a guideline-oriented inpatient psychiatric and psychotherapeutic treatment of patients with OCD and compare the necessary resources with the resources available according to Psych-PV., Methods: Based on the German national guidelines for OCD and a meta-analysis on treatment intensity, we formulated a normative weekly treatment plan. Based on this plan we calculated the necessary personnel resources and compared these with the resources available according to Psych-PV category A1 (standard care)., Results: The weekly treatment time for a guideline-oriented inpatient psychiatric and psychotherapeutic treatment of patients with OCD is 23.5 h per week. This corresponds to a weekly personnel requirement of 20.9 h. This requirement is only partly reflected in the Psych-PV (17.3 h, 82.8 %). The coverage of personnel resources by Psych-PV is even lower for psychotherapy provided by psychiatrist and psychologists (38.3 %, i. e. 183 min in the normative plan versus 70 min in Psych-PV)., Conclusions: The current paper shows that the personal resources required for a guideline-oriented inpatient psychiatric and psychotherapeutic treatment of patients with OCD is not adequately reflected in the German psychiatry personnel regulation (Psych-PV). The actual shortage may be underestimated in our paper.
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- 2016
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8. [Tricyclic antidepressants for initial treatment of depressive episodes? Con].
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Adli M and Berger M
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- Adult, Aged, Antidepressive Agents, Tricyclic adverse effects, Comorbidity, Contraindications, Female, Guideline Adherence, Humans, Male, Middle Aged, Risk Factors, Selective Serotonin Reuptake Inhibitors adverse effects, Selective Serotonin Reuptake Inhibitors therapeutic use, Treatment Outcome, Antidepressive Agents, Tricyclic therapeutic use, Depressive Disorder drug therapy
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- 2016
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9. [A detailed description of the method of comparison between normative personnel requirements and Psych-PV].
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Berger M
- Subjects
- Humans, Hospitals, Psychiatric, Personnel Staffing and Scheduling
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- 2016
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10. [Guideline-conform inpatient psychiatric psychotherapeutic treatment of chronic depression: Normative personnel requirements].
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Schnell K, Hochlehnert A, Berger M, Wolff J, Radtke M, Schramm E, Normann C, and Herpertz SC
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- Adult, Aged, Chronic Disease, Clinical Competence economics, Clinical Competence standards, Depression economics, Depression psychology, Female, Germany epidemiology, Guideline Adherence economics, Guideline Adherence standards, Guideline Adherence statistics & numerical data, Hospitals, Psychiatric economics, Humans, Male, Middle Aged, Needs Assessment economics, Personnel Staffing and Scheduling economics, Practice Guidelines as Topic, Prevalence, Psychotherapy economics, Psychotherapy statistics & numerical data, Utilization Review, Workforce, Young Adult, Depression therapy, Hospitals, Psychiatric standards, Hospitals, Psychiatric statistics & numerical data, Personnel Staffing and Scheduling statistics & numerical data, Psychiatry economics, Psychiatry standards, Psychiatry statistics & numerical data, Psychotherapy standards
- Abstract
Background: Chronic depression is a frequent mental disorder representing a significant subjective and economic burden. Effective disorder-specific treatment of chronic depression presupposes sufficient funding of treatment resources., Objective: Definition of normative needs of personnel resources for guideline-compliant and evidence-based inpatient treatment of chronic depression based on treatment duration and intensity. The personnel resources determined were compared to the resources provided on the basis of the existing reimbursement system (Psych-PV) in Germany., Material and Methods: Resources determined according to national treatment guidelines and empirical evidence were compared to personnel resources dictated by the German Psych-PV reimbursement algorithm., Results: The current funding algorithm greatly underestimates the resources needed for a guideline-compliant and evidence-based treatment program, even if healthcare providers received 100 % reimbursement of the sum determined by the Psych-PV algorithm., Discussion: The results clearly show that even in the case of a full coverage of the current German reimbursement algorithm, funding allocation for evidence-based inpatient treatment of chronic depression is insufficient. In addition, the difficulties of specific coding of chronic depression in the ICD-10 system generates a major problem in the attempt to measure the current resources needed for sufficient treatment.
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- 2016
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11. [Guideline-conform psychiatric psychotherapeutic treatment for patients with schizophrenia : A normative evaluation of necessary personnel requirements].
- Author
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Mehl S, Falkai P, Berger M, Löhr M, Rujescu D, Wolff J, and Kircher T
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- Adult, Aged, Chronic Disease, Clinical Competence economics, Clinical Competence standards, Germany epidemiology, Guideline Adherence economics, Guideline Adherence standards, Guideline Adherence statistics & numerical data, Hospitals, Psychiatric economics, Humans, Middle Aged, Needs Assessment economics, Personnel Staffing and Scheduling economics, Practice Guidelines as Topic, Prevalence, Psychotherapy economics, Psychotherapy statistics & numerical data, Schizophrenia economics, Schizophrenic Psychology, Utilization Review, Workforce, Young Adult, Hospitals, Psychiatric standards, Hospitals, Psychiatric statistics & numerical data, Personnel Staffing and Scheduling statistics & numerical data, Psychiatry economics, Psychiatry standards, Psychiatry statistics & numerical data, Psychotherapy standards, Schizophrenia therapy
- Abstract
Background: Although national treatment guidelines and current publications of the German Federal Joint Committee (Gemeinsamer Bundesausschuss) recommend cognitive behavior therapy for all patients with schizophrenia, the implementation of these recommendations in current inpatient and outpatient treatment is only rudimentary., Objectives: The aim of this study was to systematically search randomized controlled studies (RCTs), meta-analyses and the guidelines of the German Association for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) and the British National Institute for Health and Clinical Excellence (NICE) in order to assess the number of personnel necessary for psychiatric and therapeutic inpatient treatment in line with present guidelines. Moreover, the number of staff required was compared with the personnel resources designated by the German psychiatry personnel regulations (Psych-PV)., Methods: The German and NICE guidelines, RCTs and meta-analyses were analyzed and an adequate weekly treatment plan for an inpatient unit was developed. Moreover, the number of personnel necessary to realize the treatment plan was calculated., Results: In order to realize adequate inpatient treatment approximately 107 min extra for medical psychotherapeutic personnel per patient and week (of which 72 min for psychotherapy) and another 60 min for nursing staff per patient and week are required in addition to the current Psych-PV regulations. Thus, implementation in an open ward with 20 inpatients would require 3.62 positions for physicians, 0.7 positions in psychology and 12.85 positions for nursing staff (including management positions and night shifts)., Discussion: These evidence-based recommendations for precise specifications of inpatient treatment should lead to improved inpatient treatment in line with present guidelines. Moreover, outpatients and day patients could be included in this treatment model. The results should be considered in the construction of the future prospective payment system for inpatient psychiatric healthcare in Germany.
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- 2016
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12. [Guideline-oriented inpatient psychiatric psychotherapeutic/psychosomatic treatment of anxiety disorders : How many personnel are need?].
- Author
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Bandelow B, Lueken U, Wolff J, Godemann F, Wolff-Menzler C, Deckert J, Ströhle A, Beutel M, Wiltink J, Domschke K, and Berger M
- Subjects
- Adult, Aged, Anxiety Disorders economics, Anxiety Disorders epidemiology, Chronic Disease, Clinical Competence economics, Clinical Competence standards, Germany epidemiology, Guideline Adherence economics, Guideline Adherence standards, Guideline Adherence statistics & numerical data, Hospitals, Psychiatric economics, Humans, Middle Aged, Needs Assessment economics, Personnel Staffing and Scheduling economics, Practice Guidelines as Topic, Prevalence, Psychotherapy economics, Psychotherapy statistics & numerical data, Utilization Review, Workforce, Young Adult, Anxiety Disorders therapy, Hospitals, Psychiatric standards, Hospitals, Psychiatric statistics & numerical data, Personnel Staffing and Scheduling statistics & numerical data, Psychiatry economics, Psychiatry standards, Psychiatry statistics & numerical data, Psychotherapy standards
- Abstract
Background/objectives: The reimbursement of inpatient psychiatric psychotherapeutic/psychosomatic hospital treatment in Germany is regulated by the German personnel ordinance for psychiatric hospitals (Psych-PV), which has remained unchanged since 1991. The aim of this article was to estimate the personnel requirements for guideline-adherent psychiatric psychotherapeutic hospital treatment., Methods: A normative concept for the required psychotherapeutic "dose" for anxiety disorders was determined based on a literature review. The required staffing contingent was compared to the resources provided by the Psych-PV based on category A1., Results: According to the German policy guidelines for outpatient psychotherapy, a quota of 25 sessions of 50 min each (as a rule plus 5 probatory sessions) is reimbursed. This approach is supported by studies on dose-response relationships. As patients undergoing inpatient treatment for anxiety disorders are usually more severely ill than outpatients, a contingent of 30 sessions for the average treatment duration of 5 weeks seems appropriate in order to fully exploit the costly inpatient treatment time (300 min per patient and week). In contrast, only 70 min are reimbursed according to the Psych-PV. The total personnel requirement for the normative concept is 624 min per patient and week. The Psych-PV only covers 488 min (78 %)., Conclusion: Currently, the time contingents for evidence-based psychiatric psychotherapeutic/psychosomatic hospital care are nowhere near sufficient. In the development of future reimbursement systems this needs to be corrected.
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- 2016
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13. [Interpersonal violence in the context of affective and psychotic disorders].
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Maier W, Hauth I, Berger M, and Saß H
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- Affective Disorders, Psychotic psychology, Diagnosis, Differential, Humans, Interpersonal Relations, Prognosis, Psychotic Disorders psychology, Risk Assessment, Stereotyping, Treatment Outcome, Affective Disorders, Psychotic diagnosis, Affective Disorders, Psychotic therapy, Psychotic Disorders diagnosis, Psychotic Disorders therapy, Violence prevention & control, Violence psychology
- Abstract
Some mental and neurobiological disorders are associated with an increased risk for violence against others. The stigmatization of people with mental illnesses essentially emerges from a distorted perception of this condition. This review article summarizes the available literature on the determinants, prevention, therapy and tools for prediction of serious interpersonal aggression in the context of people with mental disorders. The risks for violence against other people show substantial variation between the various diagnoses. Schizophrenia and mania carry a clearly increased risk particularly at the onset of the disorder but disease-specific pharmacological therapy can reduce these risks. The highest risk factors are in particular previous violence, misuse of alcohol and drugs, male gender and young age. Probabilistic predictions of subsequent aggression against others on an individual-specific basis are only feasible in enriched populations (especially persons with mental illnesses and a previous history of assaults). Valid individual-specific predictions of future violence in the general population or on the basis of diagnoses of mental illness are, however, currently not feasible with sufficient accuracy.
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- 2016
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14. [Where is convergence of psychiatry budgets leading to? A comparison of staffing regulations and actual personnel resources].
- Author
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Wolff J, Berger M, Normann C, Godemann F, Hauth I, Klimke A, and Löhr M
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- Budgets legislation & jurisprudence, Budgets statistics & numerical data, Germany, Health Workforce statistics & numerical data, Personnel Staffing and Scheduling statistics & numerical data, Psychiatry legislation & jurisprudence, Health Workforce economics, Patient Acceptance of Health Care statistics & numerical data, Personnel Staffing and Scheduling economics, Personnel Staffing and Scheduling legislation & jurisprudence, Psychiatry economics
- Abstract
Background: Staffing regulations have determined the number of qualified staff required for sufficient, appropriate and economical inpatient mental health care in Germany since 1991. This minimum level of structural quality will probably be abolished in the context of the convergence of hospital budgets starting in 2019., Aims and Objectives: The aim of this study was to analyze the current fulfilment of staffing regulations in terms of time per patient in a large nationwide sample., Material and Methods: The required minutes of staff time as defined by staffing regulations were calculated for each patient using the treatment classifications provided by a large nationwide database. The actual use of staff time was calculated on the basis of average costs published by the German Institute for Hospital Reimbursement. Both figures were compared to calculate the fulfilment of staffing regulations., Results: The study included approximately 95,000 inpatient episodes from 46 psychiatric hospitals and departments with a total length of stay of almost 2.5 million days. On average, the weekly use of staff resources per patient was 190 min (10 %) below the requirements of the staffing regulations. The largest gap in absolute terms was found in nursing staff where the weekly time per patient was 189 min (14 %) below the requirements of the staffing regulations., Conclusion: The convergence of psychiatric hospital budgets starts in 2019 below a level of funding required to fulfil staffing regulations. This would perpetuate inadequately funded structures and should initially be opposed with a demand for complete fulfilment of staffing regulations. Thereafter, a normative consent should be reached to define the resources required for current inpatient mental health care.
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- 2015
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15. [Resource use and financing of guideline-adherent psychotherapeutic inpatient care].
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Normann C, Wolff J, Hochlehnert A, Klein JP, Hohagen F, Lieb K, Deckert J, Falkai P, Berger M, and Herpertz SC
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- Financing, Government standards, Germany, Guideline Adherence economics, Guideline Adherence standards, Health Care Rationing standards, Hospitals, Psychiatric standards, Humans, Practice Guidelines as Topic, Utilization Review, Financing, Government economics, Health Care Rationing economics, Hospitals, Psychiatric economics, Mental Disorders economics, Mental Disorders therapy, Psychotherapy statistics & numerical data
- Abstract
Background: The financing of psychiatric psychotherapeutic care in Germany is determined by the German psychiatric staffing regulations which are unchanged since 1991. Psychotherapy was established after 1991 as an effective and indispensable treatment of mental and behavioral disorders., Aims and Objectives: The aim of this study was to empirically investigate the use of psychiatrists' and psychologists' working time for psychotherapy in guideline-adherent hospital care. A further aim was to compare these results to the resources defined by the German psychiatric staffing regulations and in the new prospective payment system for psychiatry and psychosomatics in Germany., Material and Methods: University hospitals for psychiatry and psychotherapy were asked to retrospectively provide data of patients for which guideline-adherent care was possible. Participating institutions provided both data describing the staff time utilization of psychotherapeutic services provided by psychiatrists and psychologists and patient classifications according to the German psychiatric staffing regulations and the new prospective payment system for psychiatry and psychosomatics., Results: Resources defined by the German psychiatric staffing regulations covered a mean of only 71 min of psychotherapy per patient and week while the actual mean intensity of psychotherapeutic care provided by the participating hospitals was 194 min per patient and week. The associated use of staff time was 102 min per patient and week. Both figures increased during an inpatient episode. The resources defined by the German psychiatric staffing regulations covered only 70 % of medical and psychological personnel. The current configuration of the new prospective payment system for psychiatry and psychosomatics covered only 59 % of staff time., Conclusion: The results of this study provide another unambiguous recommendation to adjust the out-dated German psychiatric staffing regulations to the current evidence and S3 guidelines for psychiatric psychotherapeutic hospital care. In particular, more resources are required for the provision of psychotherapeutic care.
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- 2015
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16. [Guideline-adherent psychiatric-psychotherapeutic hospital care: Normative definition of staff required using the example of depression].
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Berger M, Wolff J, Normann C, Godemann F, Schramm E, Klimke A, Heinz A, and Herpertz SC
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- Depressive Disorder psychology, Germany, Guideline Adherence statistics & numerical data, Humans, Practice Guidelines as Topic, Psychotherapy standards, Utilization Review, Workload, Depressive Disorder therapy, Hospitals, Psychiatric standards, Hospitals, Psychiatric statistics & numerical data, Personnel Staffing and Scheduling standards, Personnel Staffing and Scheduling statistics & numerical data, Psychotherapy statistics & numerical data
- Abstract
Background: Unipolar depression is of high relevance in German inpatient treatment. An effective psychiatric psychotherapeutic hospital treatment also requires sufficient staff for carrying out psychotherapeutic treatment., Aims and Objectives: The aim of this study was to define the staff requirements for guideline-adherent psychiatric-psychotherapeutic inpatient treatment of depression on the basis of a weekly treatment schedule for a 5-week admission period. A further aim was to compare the staff required with the resources defined by the German psychiatric staffing regulations (Psych-PV)., Material and Methods: The weekly schedule was normatively defined on the basis of the current evidence for treatment efficacy and effectiveness. The staff required was calculated on the basis of the weekly schedule. The time for psychotherapy defined by the Psych-PV was calculated using the treatment classification provided by a large nationwide database., Results: Regarding psychotherapy, 280 min per week is regarded as necessary and usually sufficient according to the current evidence. The results showed clearly higher requirements of working time of psychiatrists and psychologists than those defined by the Psych-PV. In particular, the Psych-PV allows only 72 min for psychotherapy per patient and week and only a limited amount of direct patient contact with psychiatrists., Conclusion: The figures provided impressively show that the Psych-PV does not allow effective guideline-adherent hospital treatment within a reasonable length of hospital stay. Despite its evidential effectiveness, psychotherapeutic treatment cannot be sufficiently provided under the current financing circumstances.
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- 2015
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17. [Prevention and treatment of mental disorders in the workplace: staged spectrum of care].
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Berger M, Gravert C, Schneller C, and Maier W
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- Burnout, Professional psychology, Humans, Mental Disorders psychology, Occupational Diseases psychology, Occupational Medicine methods, Burnout, Professional diagnosis, Burnout, Professional prevention & control, Mental Disorders diagnosis, Mental Disorders prevention & control, Occupational Diseases diagnosis, Occupational Diseases prevention & control, Primary Prevention methods
- Abstract
Mental disorders connected with work stress are of growing importance for the health care system. Following a heated debate on burnout in Germany, at present various approaches on how to prevent the development of burnout syndromes, how to ensure a need adapted treatment for employees with a manifest disorder and how the process of returning to work already addresses aspects of secondary prevention are under discussion. This leads to different fields of activities for company health management and the health care system and structural improvements are essential.
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- 2013
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18. [Burnout].
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Berger M
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- Burnout, Professional psychology, Humans, Mental Disorders psychology, Occupational Diseases psychology, Burnout, Professional diagnosis, Burnout, Professional therapy, Mental Disorders diagnosis, Mental Disorders therapy, Occupational Diseases diagnosis, Occupational Diseases therapy
- Published
- 2013
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19. [Interpersonal psychotherapy for work-related stress depressive disorders].
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Schramm E and Berger M
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- Burnout, Professional psychology, Depressive Disorder psychology, Germany, Humans, Occupational Diseases psychology, Workload psychology, Burnout, Professional diagnosis, Burnout, Professional therapy, Depressive Disorder diagnosis, Depressive Disorder therapy, Occupational Diseases diagnosis, Occupational Diseases therapy, Psychotherapy methods
- Abstract
In general work involves health promoting functions but can also have hazardous impacts on well-being. Due to a massive change in working conditions it has become increasingly more recognized that depressive disorders are highly prevalent at the workplace and that work stress belongs to the most common triggers of depressive disorders, particularly in men. It is relevant to differentiate between subjectively experienced burnout and clinical depression. The best investigated psychosocial work stressors include increased job demands in connection with low control possibilities and lack of gratification, interpersonal conflicts, role stress and social isolation. For the treatment of work-related clinical depression, an additional focus of interpersonal psychotherapy (IPT) of depression, namely "work-related stress and burnout experience" was conceptualized based on a vulnerability-stress model and the fact that work usually takes place in an interpersonal context. This new problem area focuses on role stress and conflicts at work and the reduction of stressful working conditions. Interpersonal psychotherapy has so far been useful for the treatment of depression due to problems at work; however, further studies are needed to evaluate the efficacy of this newly designed problem area.
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- 2013
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20. [Work, mental disorders and burnout: concepts and developments in diagnostics, prevention and therapy].
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Berger M, Schneller C, and Maier W
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- Burnout, Professional complications, Diagnosis, Differential, Humans, Mental Disorders complications, Occupational Diseases complications, Burnout, Professional diagnosis, Burnout, Professional therapy, Mental Disorders diagnosis, Mental Disorders therapy, Occupational Diseases diagnosis, Occupational Diseases therapy
- Abstract
The term burnout is associated with an intensive debate on psychological stress in the modern working environment and the potential risks for mental health imposed by working conditions. However, this important discourse on how to design working conditions is hindered by a lack of differentiation of several distinct entities: prevention of mental work strain on the one hand and treatment care for persons affected by burnout syndrome accompanied by a manifest psychiatric disorder on the other. In view of these rather different work fields several shortcomings need to be pointed out: in Germany psychosocial risk assessment and prevention of mental work strain are insufficiently carried out on a company level. Means of interventions for people with pure burnout syndrome are numerous but the evaluation in terms of efficiency and long-term effects cannot be considered satisfactory in view of the existing studies. Therapy for patients with an existing psychiatric disorder and burnout should incorporate and focus on the working context as well, for example with a corresponding facultative module. For these groups an all-encompassing stepped-care model should be developed by involving all relevant players on the company level, the political level and the healthcare system.
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- 2012
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21. [Differential indications for psychotherapy exemplified by depression].
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Schramm E and Berger M
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- Depression psychology, Germany epidemiology, Humans, Prevalence, Treatment Outcome, Depression epidemiology, Depression therapy, Outcome Assessment, Health Care methods, Outcome Assessment, Health Care statistics & numerical data, Psychotherapy methods, Psychotherapy statistics & numerical data
- Abstract
The general efficacy of psychotherapeutic approaches in the treatment of mental disorders has been demonstrated by meta-analyses. Disorder-specific methods are increasingly dominating the field. In the field of depression psychological interventions have proven to be as equally effective as pharmacotherapy in mild and moderate depressives but with longer lasting effects after termination of treatment. The combination of both methods is particularly relevant for the therapy of severe and chronic depression. The indications should be differentiated beyond the severity and course of the disorder, e.g. according to previous traumatization, comorbidity, patient difficulty and the empirical evidence of the different approaches.
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- 2011
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22. [Evidence-based therapy of depression: S3 guidelines on unipolar depression].
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Härter M, Klesse C, Bermejo I, Bschor T, Gensichen J, Harfst T, Hautzinger M, Kolada C, Kopp I, Kühner C, Lelgemann M, Matzat J, Meyerrose B, Mundt C, Niebling W, Ollenschläger G, Richter R, Schauenburg H, Schulz H, Weinbrenner S, Schneider F, and Berger M
- Subjects
- Clinical Trials as Topic, Germany, Humans, Depressive Disorder diagnosis, Depressive Disorder therapy, Evidence-Based Medicine standards, Neurology standards, Practice Guidelines as Topic
- Abstract
Unipolar depressive disorders are among the most frequent reasons for utilizing the health care system. Although efficacious treatments are available and further advances have recently been made there is still a need for improving diagnostic and therapeutic procedures. Alignment of treatment on evidence-based treatment guidelines establishes an essential mainstay. The new S3 and National Health Care guidelines on unipolar depression, the compilation of which was coordinated by the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN) and which were approved by 29 scientific and professional associations, is the ambitious effort to present state of the art evidence and clinical consensus for the treatment of depression. For pharmacotherapy of depression differentiated recommendations can be given, also separate from and in addition to psychotherapy.
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- 2010
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23. [Options, limits and ethics of pharmacological neuroenhancement].
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Normann C, Boldt J, Maio G, and Berger M
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- Germany, Humans, Arousal drug effects, Biomedical Enhancement ethics, Biomedical Enhancement methods, Central Nervous System Stimulants administration & dosage, Central Nervous System Stimulants adverse effects, Cognition drug effects
- Abstract
Pharmacological neuroenhancement is an attempt to increase cognitive performance in healthy humans. Learning and memory, attention and vigilance or mood and social interaction are targeted by a modulation of brain plasticity. Firstly, an analysis of the current state of research shows that, until now, clinical trials of neuroenhancing drugs have demonstrated only limited efficacy and long-term side effects remain largely unexplored. Secondly, we argue that, from an ethical perspective, neuroenhancement differs from socially mediated methods of learning. Pharmacological neuroenhancement is based on notions of efficacy and control that threaten to undermine other important aspects of mental capacities.
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- 2010
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24. [Interpersonal psychotherapy and pharmacotherapy for post-stroke depression. Feasibility and effectiveness].
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Finkenzeller W, Zobel I, Rietz S, Schramm E, and Berger M
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- Aged, Antidepressive Agents therapeutic use, Causality, Combined Modality Therapy methods, Combined Modality Therapy statistics & numerical data, Comorbidity, Feasibility Studies, Female, Germany epidemiology, Humans, Incidence, Interpersonal Relations, Male, Middle Aged, Treatment Outcome, Depression epidemiology, Depression rehabilitation, Psychotherapy statistics & numerical data, Sertraline therapeutic use, Stroke epidemiology, Stroke Rehabilitation
- Abstract
Background: Only few studies investigated the effectiveness of psychotherapy in post-stroke depression (PSD). The aim of this feasibility study was to compare interpersonal psychotherapy, pharmacotherapy, and their combination regarding depression and rehabilitation outcome., Patients and Methods: Post-stroke depression was found in 35% of 485 stroke patients examined. Seventy-four PSD patients were randomised to one of three treatment conditions. Severity of depression was measured by the Hamilton Depression Rating Scale and the Hospital Anxiety and Depression Scale. The Barthel Index and a questionnaire for health-related quality of life were used as measurements of rehabilitation outcome., Results: There were no significant differences between the three groups in patient mood or rehabilitation outcome. Concerning the severity of depression, quality of life, and social support, all patients showed benefits from antidepressive treatment. In addition a correlation was found between rehabilitation outcome and depression., Conclusion: In this feasibility study all antidepressive treatments were successfully implemented in the rehabilitation of post-stroke depressed patients. Combination therapy (interpersonal psychotherapy plus medication) was as effective as one of those elements alone. Because of the small sample size however, further randomized trials are required.
- Published
- 2009
- Full Text
- View/download PDF
25. [Affective disorders. The significance of psychotherapeutic approaches].
- Author
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Berger M, Brakemeier EL, Klesse C, and Schramm E
- Subjects
- Depression psychology, Humans, Depression diagnosis, Depression therapy, Psychotherapy methods
- Abstract
The use of psychotherapeutic strategies is essential in the treatment of affective disorders. Psychotherapy proved to be at least equivalent to antidepressant medication in the treatment of mild to moderate depression. In severe cases, the combination of both treatments is considered by guidelines to be the standard treatment. Psychotherapeutic approaches show a longer latency than antidepressants; however, the effects are longer lasting. Regarding the effectiveness of pharmacotherapy sobering results have been published recently. Therefore, the further development of psychotherapy deserves special attention. Cognitive behavioral therapy and interpersonal therapy provide the highest evidence. The empirical basis for psychodynamic psychotherapies is still limited. In the treatment of chronic depression a new approach--cognitive behavioral analysis system of psychotherapy--is gaining importance. There is a trend towards an increasing specification of psychotherapy for distinct subgroups of depressed patients. Challenges for the future include increasing treatment efficacy, investigating mechanisms of efficacy and predictors for a differential indication, and making effective approaches generally available to all patients.
- Published
- 2009
- Full Text
- View/download PDF
26. [Clinical teaching with simulated patients in psychiatry and psychotherapy. A controlled pilot study].
- Author
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Wündrich M, Peters J, Philipsen A, Kopasz M, Berger M, and Voderholzer U
- Subjects
- Educational Measurement, Germany, Humans, Mental Disorders psychology, Patients, Pilot Projects, Students, Medical statistics & numerical data, Curriculum, Education, Medical methods, Mental Disorders diagnosis, Mental Disorders therapy, Patient Simulation, Psychiatry education, Psychotherapy education
- Abstract
Because of the new medical licensure act in Germany, much more bedside teaching than before is needed. For many of the relevant clinical pictures, few patients can be expected to undergo study lessons. That is why many universities use simulated patients (SP). In contrast to other disciplines such as internal medicine or surgery, there is not much literature about SP in psychiatry and psychotherapy. The objective of this pilot study was to evaluate if SP used for clinical teaching in addition to real patients are well accepted for simulation of psychiatric illnesses and clinical teaching. After randomization, one half of the 139 study medical students were taught using real patients and the other half using real patients and SP. The amounts of patient contact were equal in both groups. Using a questionnaire, pre- and postanalysis was carried out of answers about communication skills, the capability of addressing difficult subjects such as suicidality, and interest in psychiatry. The acceptance rate of SP was very high. Students' ratings of clinical teaching and their own performance, and their interest in future psychiatric work were significantly higher in the SP group. The results of this pilot study are very encouraging and indicate that the systematic use of SP in clinical psychiatric teaching is not only an appropriate alternative to real patients but also can lead to higher quality.
- Published
- 2008
- Full Text
- View/download PDF
27. [Cost predictors of depressive inpatient episodes in Germany. The health insurer's point of view].
- Author
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Stamm K, Salize HJ, Härter M, Brand S, Sitta P, Berger M, Gaebel W, and Schneider F
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Costs and Cost Analysis, Depressive Disorder therapy, Episode of Care, Female, Germany, Humans, Linear Models, Male, Middle Aged, Statistics as Topic, Total Quality Management economics, Depressive Disorder economics, Health Care Costs statistics & numerical data, Health Resources economics, Hospitalization economics, National Health Programs economics
- Abstract
Background: Inpatient treatment is the most costly sector of treatment for depressive disorders in Germany. However, little is known about which patient and hospital characteristics contribute to costs of inpatient episodes., Patients and Methods: To take part in this study, patients had to fullfill criteria for ICD-10 diagnosis of F31.3-F31.5, F32, F33, F34.1, F43.20, or F43.21. Episodes were recorded between September 9 2001 and March 3 2003 in ten hospitals in three German states. Inpatient records of 1,202 persons were analysed. Multiple regression analysis was performed to identify significant patient predictors of cost per inpatient episode, and the predictive function of hospital characteristics was analysed by applying hierarchical linear modeling., Results: Patient characteristics at admission could not explain a substantial part of the variance in episode costs. Better prediction was possible including variables from the whole treatment process. Also, conditions for admission and patient-related factors did not well explain cost differences between hospitals, but characteristics of the whole treatment were., Conclusion: For predicting costs of inpatient depressive episodes, the complete course treatment has to be considered. As in the physiologic sector, therapeutic and diagnostic procedures have a great effect on cost prediction.
- Published
- 2007
- Full Text
- View/download PDF
28. [A specific therapy for chronic depression. McCullough's Cognitive Behavioral Analysis System of Psychotherapy].
- Author
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Schramm E, Caspar F, and Berger M
- Subjects
- Antidepressive Agents therapeutic use, Awareness, Chronic Disease, Combined Modality Therapy, Depressive Disorder diagnosis, Depressive Disorder psychology, Depressive Disorder, Major diagnosis, Depressive Disorder, Major psychology, Depressive Disorder, Major therapy, Humans, Research, Transfer, Psychology, Transference, Psychology, Treatment Outcome, Cognitive Behavioral Therapy methods, Depressive Disorder therapy
- Abstract
Chronic depression is a common disorder which causes significant impairment and enormous treatment costs. Traditional pharmacological and psychological treatment approaches have shown only modest success. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) by James McCullough is the only therapy developed specifically for chronic depression. It integrates behavioral, cognitive, and interpersonal strategies. The approach is supported empirically and shown to be effective. This article presents the state of the art regarding research in psychotherapeutic treatment for chronic depression. In addition, the development of the approach and therapeutic strategies and techniques of CBASP are described.
- Published
- 2006
- Full Text
- View/download PDF
29. [Data supporting quality circle management of inpatient depression treatment].
- Author
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Brand S, Härter M, Sitta P, van Calker D, Menke R, Heindl A, Herold K, Kudling R, Luckhaus C, Rupprecht U, Sanner D, Schmitz D, Schramm E, Berger M, Gaebel W, and Schneider F
- Subjects
- Attitude of Health Personnel, Female, Germany epidemiology, Humans, Male, Middle Aged, Treatment Outcome, Depressive Disorder epidemiology, Depressive Disorder therapy, Hospitals, Psychiatric statistics & numerical data, Management Quality Circles, Quality Assurance, Health Care methods
- Abstract
Background: Several quality assurance initiatives in health care have been undertaken during the past years. The next step consists of systematically combining single initiatives in order to built up a strategic quality management., Methods: In a German multicenter study, the quality of inpatient depression treatment was measured in ten psychiatric hospitals. Half of the hospitals received comparative feedback on their individual results in comparison to the other hospitals (bench marking). Those bench markings were used by each hospital as a statistic basis for in-house quality work, to improve the quality of depression treatment., Results: According to hospital differences concerning procedure and outcome, different goals were chosen. There were also differences with respect to structural characteristics, strategies, and outcome. The feedback from participants about data-based quality circles in general and the availability of bench-marking data was positive. The necessity of carefully choosing quality circle members and professional moderation became obvious., Conclusions: Data-based quality circles including bench-marking have proven to be useful for quality management in inpatient depression care.
- Published
- 2005
- Full Text
- View/download PDF
30. [Are bonus systems applicable to guideline-oriented depression treatment provided by general practitioners and neurologists?].
- Author
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Schneider F, Menke R, Härter M, Salize HJ, Janssen B, Bergmann F, Berger M, and Gaebel W
- Subjects
- Depression diagnosis, Germany, Health Plan Implementation, Humans, Models, Economic, Practice Patterns, Physicians' economics, Ambulatory Care economics, Ambulatory Care methods, Depression economics, Depression therapy, Practice Guidelines as Topic, Reimbursement, Incentive
- Abstract
In the outpatient treatment of depression, the potential of diagnostic and therapeutic methods is seldom exhausted resulting in variable quality of treatment and partly insufficient cost effectiveness. Implementation of a guideline-oriented reimbursement system seems to be an option to improve quality of treatment. Corresponding incentive systems have been outlined and evaluated for the health care of somatic diseases such as diabetes. Acting on these experiences, an attempt was made to utilize them for the area of psychiatric disorders. Taking depression as an example, a model for a quality-oriented, guideline-based reimbursement system for general and specialist practice is presented.
- Published
- 2005
- Full Text
- View/download PDF
31. [Guideline conformity and outcome of inpatient treatment for schizophrenia. A clinical comparison].
- Author
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Janssen B, Weinmann S, Berger M, Härter M, Held T, Leipert M, Luderer HJ, Schwarz M, Steinert T, and Gaebel W
- Subjects
- Adult, Benchmarking methods, Female, Germany epidemiology, Hospitalization statistics & numerical data, Humans, Male, Treatment Outcome, Guideline Adherence statistics & numerical data, Inpatients statistics & numerical data, Outcome Assessment, Health Care methods, Practice Guidelines as Topic, Practice Patterns, Physicians' statistics & numerical data, Schizophrenia epidemiology, Schizophrenia therapy
- Abstract
Patient outcome and guideline conformity in inpatient schizophrenia treatment was systematically evaluated and compared with 597 patients across seven psychiatric hospitals. Patient structure and treatment processes showed a great variability between hospitals. Patient characteristics, especially mental state, and the chronicity of the disease were the strongest predictors of clinical outcome. Outcome evaluation using quality indicators is only possible after case-mix adjustment taking into account prognostic factors. A poorer average clinical outcome was associated with lower guideline conformity in a variety of treatment domains. After case-mix adjustment, benchmarking is an opportunity to improve quality of treatment and promote guideline conformity.
- Published
- 2005
- Full Text
- View/download PDF
32. [Psychiatric-psychotherapeutic inpatient treatment for depression. Process and outcome quality based on a model project in Baden-Wurttemberg].
- Author
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Härter M, Sitta P, Keller F, Metzger R, Wiegand W, Schell G, Stieglitz RD, Wolfersdorf M, Felsenstein M, and Berger M
- Subjects
- Adjustment Disorders diagnosis, Adjustment Disorders epidemiology, Adjustment Disorders therapy, Adult, Aged, Aged, 80 and over, Benchmarking statistics & numerical data, Bipolar Disorder diagnosis, Bipolar Disorder epidemiology, Combined Modality Therapy, Data Interpretation, Statistical, Depressive Disorder diagnosis, Depressive Disorder epidemiology, Dysthymic Disorder diagnosis, Dysthymic Disorder epidemiology, Dysthymic Disorder therapy, Female, Germany, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Multicenter Studies as Topic, Patient Satisfaction statistics & numerical data, Pilot Projects, Psychotropic Drugs therapeutic use, Bipolar Disorder therapy, Depressive Disorder therapy, Outcome and Process Assessment, Health Care statistics & numerical data, Patient Admission statistics & numerical data, Psychotherapy statistics & numerical data, Quality Assurance, Health Care statistics & numerical data
- Abstract
During 1998-2000 a quality assurance program for diagnosis and treatment of depression was conducted in 24 hospitals for psychiatry and psychotherapy in Baden-Wurttemberg (southern Germany). Process and outcome quality of 3,000 depressive patients was documented at admission and discharge. The article focuses on therapeutic measures, duration, outcome, patient satisfaction, and their interactions. The results show that the patients' satisfaction with the care received is very high and the pre-post effect sizes of inpatient treatment for depression are high.
- Published
- 2004
- Full Text
- View/download PDF
33. [Addressed to the Federal Professional Society of Rehabilitation on "Planning ambulatory rehabilitation of psychosomatic and psychiatric diseases" 15 January 2003].
- Author
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Berger M, Bergmann F, and Roth-Sackenheim C
- Subjects
- Cost-Benefit Analysis trends, Forecasting, Germany, Humans, Patient Care Team trends, Ambulatory Care trends, Health Planning trends, Mental Disorders rehabilitation, National Health Programs trends, Psychophysiologic Disorders rehabilitation
- Published
- 2003
34. [Non-restorative sleep and insomnia. Diagnostic and therapeutic options for psychiatry and psychotherapy].
- Author
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Riemann D, Voderholzer U, and Berger M
- Subjects
- Algorithms, Circadian Rhythm, Cognitive Behavioral Therapy, Combined Modality Therapy, Diagnosis, Differential, Diagnostic and Statistical Manual of Mental Disorders, Humans, Hypnotics and Sedatives adverse effects, Hypnotics and Sedatives therapeutic use, International Classification of Diseases, Polysomnography, Prognosis, Risk Factors, Sleep Initiation and Maintenance Disorders classification, Sleep Initiation and Maintenance Disorders diagnosis, Sleep Initiation and Maintenance Disorders psychology, Psychiatry, Psychotherapy, Sleep Initiation and Maintenance Disorders therapy
- Abstract
Over the last few years, a shift in paradigm has taken place in the diagnosis and therapy of insomnia. Traditionally, treatment focused on improving night sleep, i.e. shortening sleep latency and prolonging total sleep time. Modern approaches aim at improving or restoring the recuperative value of sleep and ensuring daytime functioning on a social, psychological and professional level. Based on the guidelines "Non-restorative Sleep" of the German Society of Sleep Research and Sleep Medicine, this article presents a clinical algorithm for the diagnosis and therapy of non-restorative sleep with predominant insomnia. The term "non-restorative sleep" permits us to view the restorative value of sleep and the resulting daytime functioning of the individual afflicted with insomnia as the focus for the diagnosis of and therapy for insomnia. This algorithm is suitable for the clinical practice of outpatient psychiatric and psychotherapeutic services as well as for psychiatric inpatients. The main features for psychiatrists and psychotherapists in the diagnosis and therapy of non-restorative sleep are underlying psychiatric-psychological factors or secondary psychiatric sequelae of chronic primary insomnias. For primary, organic and psychiatric insomnias, a broad spectrum of psychopharmacological and cognitive behavioral methods can be applied either alone or in combination.
- Published
- 2003
- Full Text
- View/download PDF
35. [Expanded inpatient care capacity for psychosomatics? German states in conflict with their own expert advisors].
- Author
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Fritze J and Berger M
- Subjects
- Forecasting, Germany, Health Services Needs and Demand trends, Humans, Health Planning trends, National Health Programs trends, Patient Admission trends, Psychophysiologic Disorders therapy, Somatoform Disorders therapy
- Published
- 2003
36. [Comorbidity of depressive disorders and cardiovascular diseases. Implications for diagnosis, pharmaco- and psychotherapy].
- Author
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Hesslinger B, Härter M, Barth J, Klecha D, Bode C, Walden J, Bengel J, and Berger M
- Subjects
- Antidepressive Agents adverse effects, Antidepressive Agents therapeutic use, Combined Modality Therapy, Comorbidity, Coronary Disease psychology, Depressive Disorder diagnosis, Depressive Disorder therapy, Drug Interactions, Humans, Myocardial Infarction psychology, Psychotherapy, Selective Serotonin Reuptake Inhibitors adverse effects, Selective Serotonin Reuptake Inhibitors therapeutic use, Coronary Disease epidemiology, Depressive Disorder epidemiology, Myocardial Infarction epidemiology
- Abstract
Controlled studies and meta-analyses show not only that depression and cardiovascular disease often occur together, but that depressive illnesses are an independent risk factor in the development and the progression of coronary heart disease. It can be difficult to distinguish between reactive mood disturbance after myocardial infarction and depressive episodes that may have preceded the infarction and which require treatment. Due to this difficulty, depressive disorders are rarely diagnosed, and only a minority of patients receive adequate treatment. However, owing to the introduction of new antidepressants in recent years, the number of treatment options has increased. Specifically, selective serotonin reuptake inhibitors (SSRI) offer a valuable alternative to tricyclic antidepressants, which are problematic in heart disease. The authors describe on the one hand controlled studies of SSRIs and discuss differential therapeutic consequences. On the other hand, studies of psychotherapeutic interventions in comorbid patients with depression and coronary heart disease are reported. Finally, the authors discuss which psychotherapeutic interventions may be suitable.
- Published
- 2002
- Full Text
- View/download PDF
37. [Psychopharmacotherapy of bipolar affective diseases].
- Author
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Grunze H, Walden J, Dittmann S, Berger M, Bergmann A, Bräunig P, Dose M, Emrich HM, Gastpar M, Greil W, Krüger S, Möller HJ, and Uebelhack R
- Subjects
- Antidepressive Agents adverse effects, Antimanic Agents adverse effects, Bipolar Disorder diagnosis, Bipolar Disorder psychology, Consensus Development Conferences as Topic, Drug Therapy, Combination, Humans, Practice Guidelines as Topic, Antidepressive Agents therapeutic use, Antimanic Agents therapeutic use, Bipolar Disorder drug therapy
- Abstract
The broadening of the classification systems for manic-depressive illness towards a spectrum of bipolar disorders implicates a more differentiated use of pharmacotherapies. However, many questions still remain open. This implies that all consensus guidelines and recommendations have to be considered as preliminary. On the other hand, research in the last decade has developed many new treatment alternatives, both for mood stabilizers and antidepressants as well as antipsychotics. These recommendations, which have been developed in the process of two consensus meetings, try to consider the broadening of the concept of bipolar disorder by differentiating between subgroups according to acute symptomatology and characteristics of the long-term course, e.g., rapid cycling. In particular, the emerging role and new indications of mood stabilizing antiepileptic drugs, atypical antipsychotics, and new antidepressants will be discussed.
- Published
- 2002
- Full Text
- View/download PDF
38. [CME neurology and CME psychiatry. Further development, adaptation to the specialty board systems, increased user friendliness, faster specialty CME certification].
- Author
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Reuther P and Berger M
- Subjects
- Curriculum, Education, Medical, Continuing standards, Germany, Humans, Neurology standards, Psychiatry standards, Certification standards, Education, Medical, Continuing organization & administration, Neurology education, Psychiatry education
- Published
- 2001
- Full Text
- View/download PDF
39. [Neurobiological findings in a patient with 48-hour rapid cycling bipolar affective disorder. A case report].
- Author
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Weske G, Berger M, Riemann D, and Voderholzer U
- Subjects
- Bipolar Disorder physiopathology, Bipolar Disorder psychology, Cerebral Cortex physiopathology, Human Growth Hormone blood, Humans, Hydrocortisone blood, Limbic System physiopathology, Male, Melatonin blood, Middle Aged, Polysomnography, Sleep Stages physiology, Thyrotropin blood, Bipolar Disorder diagnosis, Circadian Rhythm physiology, Hormones blood
- Abstract
Forty-eight-hour rapid cycling is a rare subclass of affective disorders and entails a regular periodic change of moods. The following case study describes the symptoms, therapy, and outcome of a patient suffering from daily switching between mania and depression along with neurobiological findings correlated to the affective cycles. We found alternating reduction and prolongation of sleep duration during manic and depressive days as well as differences in the amount of REM sleep. Cortisol secretion was regularly increased during depressive days. Regarding thyroid-stimulating hormone (TSH) secretion, the circadian rhythm was absent on depressive days. However, the glucose metabolic rate as measured by positron emission tomography (PET) did not differ on manic and depressive days. The patient reached almost complete remission under treatment with lithium.
- Published
- 2001
- Full Text
- View/download PDF
40. [Substance P receptor antagonists--a new antidepressive and anxiolytic mechanism?].
- Author
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Lieb K, Fiebich BL, and Berger M
- Subjects
- Anti-Anxiety Agents pharmacology, Antidepressive Agents, Second-Generation pharmacology, Anxiety Disorders drug therapy, Anxiety Disorders metabolism, Aprepitant, Depression metabolism, Humans, Morpholines pharmacology, Anti-Anxiety Agents therapeutic use, Antidepressive Agents, Second-Generation therapeutic use, Depression drug therapy, Morpholines therapeutic use, Neurokinin-1 Receptor Antagonists, Substance P antagonists & inhibitors
- Abstract
Preclinical investigations suggest that the neuropeptide substance P might be involved in the etiopathology of pain, depression, and anxiety. In a recent study, the substance P receptor antagonist MK-869 showed antidepressant and anxiolytic activity in depressed outpatients which was comparable to a standard SSRI. The MK-869 was well tolerated. Although these findings are promising, further studies are necessary to prove the hypothesis that substance P receptor antagonists represent a new class of antidepressants or anxiolytics. Respective studies are currently underway.
- Published
- 2000
- Full Text
- View/download PDF
41. [Combined CME-committee of DGPPN and BVDN: an introduction of a single CME concept for psychiatry and psychotherapy as well as neurology/psychiatry (neuroscience)].
- Author
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Berger M, Roth-Sackenheim C, Sauer H, Schmauss M, Barth-Stopik A, Bergmann F, and Vogel P
- Subjects
- Accreditation standards, Education, Medical, Continuing standards, Germany, Humans, Neurology organization & administration, Neurology standards, Neurosciences organization & administration, Neurosciences standards, Psychiatry organization & administration, Psychiatry standards, Psychotherapy organization & administration, Psychotherapy standards, Education, Medical, Continuing organization & administration, Neurology education, Neurosciences education, Psychiatry education, Psychotherapy education
- Published
- 2000
- Full Text
- View/download PDF
42. [The concept of "evidence-based medicine" in psychiatry. A path to a more rational psychiatry?].
- Author
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Berner MM, Rüther A, Stieglitz RD, and Berger M
- Subjects
- Antidepressive Agents, Tricyclic therapeutic use, Delivery of Health Care trends, Depressive Disorder drug therapy, Humans, Hypericum therapeutic use, Phytotherapy, Plants, Medicinal, Randomized Controlled Trials as Topic, Total Quality Management trends, Evidence-Based Medicine trends, Psychiatry trends, Psychotherapy trends
- Abstract
Many of the diagnostic and therapeutic procedures in psychiatry and psychotherapy are based on opinion rather than evidence. The concept of evidence-based medicine aims to bridge the gap between clinical research and clinical decision-making by integrating the best available external evidence with personal expertise. In this article, we demonstrate several examples of the non-evidence-based medicine paradigm. Then we show the usefulness and practicability of the new evidence-based medicine paradigm by using a clinical example. Finally, we discuss the consequences, chances, and limitations of this new model. We also examine the role of the individual clinician's viewpoint as well as the need of institutional re-engineering and the possible restructuring of the entire health care system towards evidence-based methods.
- Published
- 2000
- Full Text
- View/download PDF
43. [Management of mental health and primary care. Development and evaluation of a training program based on the PLISSIT approach].
- Author
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Vauth R, Härter M, Hohagen F, Kemmerich C, Herrmann JM, Haag G, Nolte J, Niebling W, Stadtmüller G, Fritzsche K, and Berger M
- Subjects
- Family Practice education, Humans, Psychosomatic Medicine education, Disease Management, Mental Health, Primary Health Care standards, Program Development
- Abstract
Deficits in current approaches of psychosomatic and psychiatric education for general practitioners are reviewed. A skill-based training was developed in line with the four step counseling approach of the "PLISSIT" approach: The GP helps in first step ("permission") the patient to accept his problem and assesses informations about causing and maintaining factors of his symptomatology. In the second step he should provide information about the disorder and reverse misunderstanding and passivity (Limited Information). The GP's should develop preliminary strategies for change in the third step ("coping strategies", "symptom management", "special suggestions") and preparate the intensive phase of therapy as the last step. First results of the evaluation of the training program are presented demonstrate the effectiveness and acceptance of the education program.
- Published
- 1999
- Full Text
- View/download PDF
44. [Significance of hepatic cytochrome P450 enzymes for psychopharmacology].
- Author
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Normann C, Hesslinger B, Bauer J, Berger M, and Walden J
- Subjects
- Cytochrome P-450 Enzyme Inhibitors, Humans, Liver drug effects, Metabolic Clearance Rate drug effects, Selective Serotonin Reuptake Inhibitors adverse effects, Cytochrome P-450 Enzyme System physiology, Liver enzymology, Psychotropic Drugs pharmacokinetics
- Abstract
Nearly all psychotropic drugs are metabolized by hepatic cytochrome P450-enzymes. In humans, there are 5 isoenzymes involved in this process. The activity of these enzymes can be modulated by a number of commonly used drugs, yielding potentially hazardous interactions. Most of the recently introduced selective serotonin reuptake inhibitors are potent inhibitors of cytochrome P450 enzymes. Thus, the plasma concentrations of tricyclic antidepressants or clozapine might be elevated into toxic levels. In contrast, carbamazepine induces most of the isoenzymes. This potentiates the elimination of tricyclics and antipsychotics and might cause a serious risk for the recurrence of depressive or psychotic symptoms. Moreover, 5-10% of the population are slow metabolizers of CYP2D6. This group is prone to increased adverse effects of moderately dosed medication. This review systematically points out the reported or predicted pharmacokinetic drug interactions in psychopharmacology focussing on clinical significance.
- Published
- 1998
- Full Text
- View/download PDF
45. [Delirium during oral therapy of herpes zoster with acyclovir. Case report and brief review of central nervous system side-effects of acyclovir].
- Author
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Braun JS, Apel I, Schäffer S, Schumacher M, and Berger M
- Subjects
- Acyclovir therapeutic use, Aged, Antiviral Agents therapeutic use, Brain drug effects, Brain pathology, Delirium diagnosis, Dementia, Vascular diagnosis, Diagnosis, Differential, Humans, Magnetic Resonance Imaging, Male, Acyclovir adverse effects, Antiviral Agents adverse effects, Delirium chemically induced, Herpes Zoster drug therapy, Psychoses, Substance-Induced diagnosis
- Abstract
In differential diagnosis of a delir also adverse effects of medicaments have to be taken into account beside other causes. We report a case of an agitated delir with nocturnal disturbance of consciousness, confusion, restlessness and sleeplessness. This delir existed exclusively during the therapy of a cutaneous herpes zoster with zovirax-pills which can only be explained by a causal connection--after exclusion of other causes. As a so far undescribed predisposition for neurotoxicity of oral therapy with acyclovir signs of vascular encephalopathy were found in the patient's cranial magnetic resonance imaging. The central nervous side effects of acyclovir were summarized shortly.
- Published
- 1998
- Full Text
- View/download PDF
46. [Microglia: mechanisms of activation and significance in pathogenesis of neuropsychiatric illnesses].
- Author
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Gebicke-Haerter PJ, Lieb K, Illes P, and Berger M
- Subjects
- AIDS Dementia Complex physiopathology, Alzheimer Disease physiopathology, Brain physiopathology, Brain Damage, Chronic diagnosis, Dementia diagnosis, Humans, Multiple Sclerosis physiopathology, Nerve Regeneration physiology, Brain Damage, Chronic physiopathology, Dementia physiopathology, Macrophage Activation physiology, Microglia physiology
- Abstract
Microglia are the resident macrophages of the brain. They are the central cellular element to initiate defense mechanisms against destructive environmental influences and to facilitate regenerative processes. No other cell type of the brain is endowed with a comparably comprehensive, immunocompetent machinery like microglia. It encompasses cell proliferation, migration and differentiation into full-blown macrophages able to present antigen and to phagocytose cell debris. Relatively little is known about these stages of microglia activation on the cellular and molecular level, although microglia have been described as a separate cell type of the brain as early as in the 30ies of this century by P.del Rio Hortega. This review summarizes the data that have accumulated until now in this respect and tries to embed them into a clinical framework. Special focus has been given to the role of this cell type in the development and progression of Multiple Sclerosis, HIV-associated dementia and Alzheimer's disease.
- Published
- 1998
- Full Text
- View/download PDF
47. [Inpatient treatment of depressed patents. Conceptual considerations and results of a pilot project for quality assurance in Baden-Württemberg].
- Author
-
Stieglitz RD, Wolfersdorf M, Metzger R, Ruppe A, Stabenow S, Hornstein C, Keller F, Schell G, and Berger M
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Discharge, Personality Inventory, Pilot Projects, Psychiatric Status Rating Scales, Depressive Disorder therapy, Patient Admission, Quality Assurance, Health Care
- Abstract
Quality-assurance activities will become more important in psychiatry during the next few years. In relation to other medical disciplines, some special aspects concerning structure, process and outcome quality as well as practical realization and methodologic aspects must be considered. These specific issues were the focus of a study dealing with the treatment of depressed inpatients. The experiences and results as well as considerations concerning future quality-assurance projects are discussed.
- Published
- 1998
- Full Text
- View/download PDF
48. [Systemic immunologic diseases as differential diagnosis in psychiatry].
- Author
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Lieb K, Vaith P, Berger M, and Bauer J
- Subjects
- Autoantibodies blood, Autoimmune Diseases immunology, Autoimmune Diseases psychology, Diagnosis, Differential, Humans, Neurocognitive Disorders immunology, Neurocognitive Disorders psychology, Neuropsychological Tests, Patient Care Team, Autoimmune Diseases diagnosis, Neurocognitive Disorders diagnosis
- Abstract
Psychiatric symptoms may be caused by systemic autoimmune diseases. Quite often, mental disorders are an early symptom during the course of an autoimmune disease and sometimes they may even be the presenting symptom. This article reviews psychiatric and neurologic symptoms in systemic lupus erythematodes, Sjögren syndrome, primary vasculitides and other immunopathies such as the primary antiphospholipid syndrome and Sneddon's syndrome. The article also discusses diagnostic aspects and therapeutic options if an autoimmune disease as cause of a psychiatric or neurologic symptom is suspected. An increased awareness of psychiatrists and neurologists will make it possible that systemic autoimmune diseases are early identified as a possible cause of psychiatric symptoms and may then be treated adequately.
- Published
- 1997
- Full Text
- View/download PDF
49. [M. Linehan dialectic behavioral psychotherapy. A new concept in the treatment of borderline personality disorders].
- Author
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Bohus M and Berger M
- Subjects
- Affective Symptoms psychology, Affective Symptoms therapy, Borderline Personality Disorder psychology, Follow-Up Studies, Humans, Problem Solving, Randomized Controlled Trials as Topic, Stress, Psychological complications, Suicide psychology, Treatment Outcome, Suicide Prevention, Behavior Therapy methods, Borderline Personality Disorder therapy
- Abstract
M. Linehan developed "dialectical behavioral therapy" specifically to treat chronically suicidal borderline patients. It rests on a biosocial model that assumes a disorder in the regulation of emotions and in tolerance of stress. The numerous dysfunctional patterns of behavior such as self-destructive behavior, inability to govern impulses or severe dissociative phenomena are regarded as attempts at problem-solving. This concept of therapy focuses on the continuing balance between the necessity of accepting maladaptive behavior patterns in both an intrapsychic and an interactional context while still working to change them. A comprehensive manual outlines the clearly structured therapy and integrates a wide choice of therapeutic strategies. Parallel to development of the therapy itself, a method also was developed for testing therapist adherence to the manual's guidelines, thus providing a basis for empirical evaluation. An initial controlled, randomized study demonstrated the significant superiority of this method to methods of unspecific psychotherapy at various levels. In the current endeavor to develop disorder-specific approaches to the treatment of personality disorders, "dialectical behavioral therapy" is a noteworthy model.
- Published
- 1996
- Full Text
- View/download PDF
50. [Chronic fatigue syndrome. Definition, diagnostic measures and therapeutic possibilities].
- Author
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Lieb K, Dammann G, Berger M, and Bauer J
- Subjects
- Adaptation, Psychological, Cognitive Behavioral Therapy, Diagnosis, Differential, Fatigue Syndrome, Chronic etiology, Fatigue Syndrome, Chronic therapy, Humans, Patient Care Team, Sick Role, Fatigue Syndrome, Chronic diagnosis
- Abstract
This article reviews the chronic fatigue syndrome (CFS), a disorder whose etiology is unknown. The diagnostic criteria proposed in 1994 by the CDC and the International Chronic Fatigue Syndrome Study Group are introduced. In contrast to widespread belief, there are no laboratory tests available to underpin the diagnosis of CFS; the diagnosis is made solely on the basis of clinical criteria. In the differential diagnosis, the exclusion of other conditions that can cause chronic fatigue, such as neuropsychiatric or sleep disorders, is of critical importance. In this context, the question as to whether CFS is a clinical entity that can be differentiated from psychiatric diagnoses, such as depression, somatoform disorder, or neurasthenia, is discussed. At the moment, there is no specific therapy for CFS. Therefore, therapeutic approaches are limited to symptomatic management of the concomitant sleep disturbances, pain, or psychiatric symptoms, such as depression. Patients may benefit from cognitive behavioral therapy, as this may help then to identify and exclude factors contributing to and maintaining chronic fatigue. An integrated medical and psychological approach should be adopted, with the aim of preventing significant secondary negative results of the illness, such as interpersonal conflicts or chronic disability.
- Published
- 1996
- Full Text
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