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The quality of socio-medical expert opinions, which are prepared for the German Pension Insurance (GPI) in the context of applications for reduced earning capacity pension due to mental disorder, has hardly been investigated so far. The aim of the present study was to investigate to what extent expert medical reports on post-traumatic stress disorder (PTSD) comply with the guideline of the GPI on socio-medical reports for mental and behavioral disorders.To examine the quality of expert opinions, 52 socio-medical expert opinions in which a diagnosis of post-traumatic stress disorder (PTSD) was assigned and a performance capacity of less than three hours was determined were analyzed. The quality of the expert opinions was assessed both quantitatively by calculating quality points and qualitatively by analyzing the content. Percent agreement and Cohen's kappa were calculated for two raters to examine rater agreement based on a subsample (n=11).The analyzed appraisals scored an average of 36.1 (SD=7.4) out of a possible 92 quality points (range 22/56). In most of the expert opinions, the descriptions of participation limitations, epicrisis, and sociomedical conclusion were unsatisfactory.The inadequate presentation of the functional and participation limitations in the expert opinions may not do justice to the actual facts of the case, so that the evidence of a health disorder with the corresponding participation limitations cannot be provided beyond doubt. Accordingly, measures to improve the quality of expert opinions such as training and regular quality reviews are necessary.ZIEL: Die Qualität von sozialmedizinischen Gutachten, die im Rahmen von Anträgen auf Erwerbsminderungsrente wegen psychischer Störung für die Deutsche Rentenversicherung (DRV) angefertigt werden, ist bislang kaum untersucht worden. In der vorliegenden Studie sollte untersucht werden, inwieweit fachärztliche Gutachten zur Posttraumatischen Belastungsstörung (PTBS) der Leitlinie der DRV zu sozialmedizinischen Gutachten bei psychischen und Verhaltensstörungen entsprechen.Zur Überprüfung der Gutachtenqualität wurden 52 sozialmedizinische Gutachten, in denen die Diagnose einer Posttraumatischen Belastungsstörung (PTBS) vergeben und ein Leistungsvermögen von unter drei Stunden festgestellt wurde, analysiert. Die Gutachtenqualität wurde sowohl quantitativ mit der Berechnung von Qualitätspunkten, als auch qualitativ durch inhaltliche Analysen erfasst. Zur Überprüfung der Beurteiler_innenübereinstimmung wurde die prozentuale Übereinstimmung und Cohens Kappa für zwei Rater_innen anhand einer Teilstichprobe (n=11) berechnet.Die analysierten Gutachten erreichten durchschnittlich 36,1 (SD=7,4) von 92 möglichen Qualitätspunkten (Range 22/56). In den meisten Gutachten waren die Beschreibungen der Teilhabeeinschränkungen, der Epikrise und der sozialmedizinischen Schlussbildung unbefriedigend. Die unzureichende Darstellung der Funktions- und Teilhabeeinschränkungen in den Gutachten wird möglicherweise dem tatsächlichen Sachverhalt nicht gerecht, so dass der Beweis einer Gesundheitsstörung mit den entsprechenden Leistungseinschränkungen nicht zweifelsfrei erbracht werden kann. Dementsprechend sind Maßnahmen zur Verbesserung der Gutachtenqualität wie Schulungen und regelmäßige Qualitätsüberprüfungen notwendig.

There is a growing consensus that emotion dysregulation is the defining feature of borderline personality disorder, but there are also persisting competing views on the pathology and dimensional structure of the disorder. The "Impulsivity and Emotion Dysregulation Scale" (IED-27) is already being used for assessing patients with borderline personality disorder. The particular aim of this study was to gain evidence of the dimensional structure of the disorder by confirmatory factorial analysis. A heterogeneous sample of patients with borderline personality disorder (n=484), attention deficit (hyperactivity) disorder (n=191) and eating disorders (n=197) of a psychosomatic clinic were given general and specific self-assessment inventories via computer-assisted testing system, including the IED-27. Results showed a bifactor model with a general factor and three specific factors: "emotional dysregulation", "relationship difficulties" and "self-injuries and suicidal behaviours", to be the model with the best fit (ΔCFI=0,032). The internal consistency of the sample seems to be good (ω=0,83-0,93) and expected correlations to similar subscales could be proved. Good psychometric criteria of the IED-27 were replicated in this study. Prospectively, the subscales allow a more detailed representation and specific treatment planning.Zwar besteht Übereinstimmung darüber, dass die gestörte Emotionsregulation ein zentrales Merkmal der Borderline-Persönlichkeitsstörung (BPS) ist, doch gibt es anhaltend weiterhin konkurrierende Ansichten zur dimensionalen Struktur der Störung. Die „Skala zur Erfassung der Impulsivität und emotionalen Dysregulation“ (IES-27) wurde bisher erfolgreich bei PatientInnen mit BPS eingesetzt. Das Ziel der vorliegenden Studie war Hinweise auf die zugrundeliegende dimensionale Struktur mithilfe konfirmatorischer Faktorenanalysen zu gewinnen. Eine heterogene Stichprobe von PatientInnen mit BPS (n=484), Aufmerksamkeits-Defizits-(Hyperaktivitäts-)Störung (n=191) und Essstörungen (n=197) einer psychosomatischen Klinik erhielt mittels computergestützter Testung verschiedene Selbstbeurteilungsinstrumente. Es zeigte sich wie vermutet ein Bi-Faktor-Modell mit einem generellen Faktor und den 3 spezifischen Faktoren „Emotionale Dysregulation“, „Beziehungsschwierigkeiten“ und „Suizidales und selbstverletzendes Verhalten“ überlegen (ΔCFI=0,032). Die interne Konsistenz der Gesamtstichprobe nahm Werte zwischen ω=0,83−0,93 an. Es zeigten sich erwartungsgemäße Zusammenhänge zu konstruktnahen Subskalen. Die psychometrischen Gütekriterien der IES-27 konnten damit bestätigt werden. Die Bildung von Subskalen erlaubt eine differenzierte Darstellung und damit eine spezifischere Behandlungsplanung.

Female genital mutilation (FGM) is a procedure that injures or removes parts of the external female genitals for nonmedical reasons and without the consent of the affected girls. Often this procedure leads to severe consequences for the women's physical and mental health. Reconstructive surgery can reduce these symptoms. In an exploratory study of 97 women seeking medical counselling, characteristics of the sample were analysed descriptively, reasons for reconstructive surgery were examined and agreement between the women's knowledge with the results of the medical examination was assessed. 56.7% (n=55) of the women examined were suspected to suffer from PTSD. Relief of pain was the reason most frequently mentioned for reconstructive surgery (45.4%; n=44). Accordance between women's knowledge of anatomic structures and the degree of mutilation with the results of the medical examination was low (κ=0.09). In addition to surgical measures, women suffering from FGM should be offered psychotherapeutic assistance. To improve the understanding on the effect of psychotherapy after FGM, sound longitudinal studies are indispensable.Bei der weiblichen Genitalverstümmelung (englisch female genital mutilation, FGM) werden die äußeren Genitalien ohne medizinischen Grund und ohne Mitspracherecht der betroffenen Mädchen beschädigt oder entfernt. Häufig geht diese Prozedur mit erheblichen Konsequenzen für die physische und psychische Gesundheit einher. Rekonstruktive chirurgische Maßnahmen können die Beschwerden der Betroffenen lindern. Anhand einer explorativen Untersuchung von N=97 Frauen, die an einem medizinischen Beratungsgespräch zur rekonstruktiven Operation teilnahmen, wurden die besonderen Charakteristika dieser Stichprobe deskriptiv analysiert, Gründe der Inanspruchnahme einer rekonstruktiven Operation erfragt, sowie das Wissen der Patientinnen über ihren Beschneidungstyp mit der medizinischen Diagnose verglichen. Bei 56,7% (n=55) der Untersuchten lag der Verdacht einer PTBS vor. Keine Schmerzen mehr zu haben war der am häufigsten genannte Grund für eine Operation (45,4%; n=44). Die Übereinstimmung zwischen dem Wissen der Patientinnen über den Beschneidungstyp und dem ärztlichen Urteil fiel gering aus (κ=0,09). Bei physischer und psychischer Belastung sollten Frauen nach FGM neben chirurgischen Maßnahmen auch psychotherapeutisch betreut werden. Psychotherapeutische Interventionen im Kontext von FGM müssen evaluiert werden. Längsschnittstudien sind hierfür unabdingbar.

So far, there is no German instrument for determining occupational stress in members of volunteer firefighting (MVF). The aim of the present study was to evaluate the Sources of Occupational Stress in FirefightersParamedics (SOOS-11). MVF were interviewed in cooperation with the fire department accident fund of Lower Saxony at three different measurement times (MT). The first MT was a questionnaire survey (November 2016-February 2017) which contained various self-assessment questionnaires (N=475). At the second MT (May 2017-November 2017) N = 117 MVF (n=55 from the first MT) participated in an interview that contained the modules of the structural clinical interview for DSM-IV (SKID-I; Wittchen, Wunderlich, GruschwitzZaudig, 1997) for diagnosing a depression and posttraumatic stress disorder. During the course of the third MT (November 2017-May 2018) a part of the second sample (n=58) answered various assessment questionnaires again. It was possible to estimate satisfactory values for the internal consistence of the SOOS-11 (α=0.73-0.76). The 6-month-test-retest-reliability was r=0.60. An explorative as well as a confirmatory factor analysis suggested an adequate model-fit for a one-factorial and a 2-factorial structure of the questionnaire. High significant correlations were found between the manifestations of the well-being, the organizational climate and the SOOS-11. Therefore, the SOOS-11 represents a good possibility for measuring occupational stress in MVF. The questionnaire should be tested with a further sample, for example members of the professional fire brigade.Bislang existiert kein deutschsprachiges Instrument zur Ermittlung von einsatzbezogener Belastung bei Mitgliedern der Freiwilligen Feuerwehr (MFF). Das Ziel der vorliegenden Studie war die Evaluation des Sources of Occupational Stress in FirefightersParamedics (SOOS-11). In Zusammenarbeit mit der Feuerwehr-Unfallkasse Niedersachsen wurden MFF zu 3 verschiedenen Messzeitpunkten (MZP) befragt. Beim ersten MZP (November 2016–Februar 2017) handelte es sich um eine Fragebogenerhebung, die diverse Selbstbeurteilungsinstrumente umfasste (N=475). Am zweiten MZP (Mai 2017 – November 2017) nahmen N = 117 MFF (davon n=55 vom ersten MZP) an einem Interview teil, das die Module des Strukturierten Klinischen Interviews für DSM-IV (SKID-I; Wittchen, Wunderlich, GruschwitzZaudig, 1997) zur Erfassung einer Depression und Posttraumatischen Belastungsstörung beinhaltete. Im Zuge des dritten MZP (November 2017–Mai 2018) wurden von einer Teilstichprobe des zweiten MZP (n=58) verschiedene Selbstbeurteilungsinstrumente erneut beantwortet. Es konnten für den SOOS-11 zufriedenstellende Werte zur Internen Konsistenz (α=0,73–0,76) geschätzt werden. Die 6-Monats-Test-Retest-Reliabilität betrug r=0,60. Eine exploratorische sowie eine konfirmatorische Faktorenanalyse ergaben für eine ein – und auch eine 2-faktorielle Struktur des Fragebogens einen adäquaten Modell-Fit. Hoch signifikante Korrelationen ergaben sich zwischen der Ausprägung des Wohlbefindens, dem Organisationsklima und dem SOOS-11. Somit stellt der SOOS-11 eine gute Möglichkeit dar, einsatzbezogene Belastung von MFF zu messen. Der Fragebogen sollte noch an einer weiteren Stichprobe, wie bspw. der Berufsfeuerwehr, erprobt werden.

Cognitive-behavioral therapy, including exposure and response management, is considered the first-choice psychotherapy for obsessive-compulsive disorder. In this study, the therapy outcome of 799 patients was examined in the context of inpatient cognitive-behavioral psychotherapy. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used as the central outcome measure. Therapy outcome was defined in effect sizes (ES) as well as in remission and response rates. In the pre-post comparison of Y-BOCS, the ES was 1.32. Response was classified according to two different definitions: the reliable change index (RCI) and the percental symptom improvement (PSI). The rates of response were 75.5% (RCI) and 37% (PSI). The rates of remission were 39.3% based on RCI and 32.2% based on PSI. 10.4 % of the participating patients finished the treatment prematurely. The risk of dropout was increased in male gender as well as in patients who were additionally treated with neuroleptics. The negative impact of neuroleptics on the outcome of therapy indicates that such medication should be used critically as part of exposure treatment.Die kognitive Verhaltenstherapie einschließlich Exposition und Reaktionsmanagement gilt bei Zwangsstörungen als Psychotherapie der ersten Wahl. In dieser Studie wurde der Therapieerfolg von 799 Patienten im Rahmen einer stationären kognitiv-behavioralen Psychotherapie untersucht. Als zentrales Erfolgsmaß wurde die Yale-Brown Obsessive Compulsive Scale (Y-BOCS) eingesetzt. Der Therapieerfolg wurde in Effektstärken (ES) sowie in Remissions- und Responseraten ausgedrückt. Im Prä-Post-Vergleich der Y-BOCS betrug die ES 1,32. Response wurde nach 2 verschiedenen Definitionen klassifiziert: dem Reliabel Change Index (RCI) und der prozentualen Symptomverbesserung (PSV). Die Responseraten betrugen 75,5% (RCI) bzw. 37% (PSV). Remission erreichten 39,3% nach RCI und 32,2% nach PSV. Von den eingeschlossenen Patienten beendeten 10,4% die Therapie vorzeitig. Das Abbruchrisiko war bei Männern sowie bei Patienten, die zusätzlich mit Neuroleptika behandelt wurden, erhöht. Der negative Einfluss von Neuroleptika auf den Therapieverlauf legt nahe, dass eine entsprechende Medikation im Rahmen der Expositionsbehandlung kritisch überprüft werden sollte.

The perception that e‑cigarettes are less harmful than traditional tobacco products can influence the consumption of e‑cigarettes.Three questions were examined: (1) How do different population groups perceive health risks of e‑cigarettes? (2) Do sociodemographic variables explain differences in the risk assessment of e‑cigarettes? (3) Does the perception of health risks predict the use of e‑cigarettes for smoking cessation?Data came from the 2015 Epidemiological Survey of Substance Abuse (ESA) with a sample size of n = 9204 participants, aged 18 to 64 years (response rate 52.2%). Data were collected by telephone, online, or by written questionnaires. Assessments of risk perception of e‑cigarettes and conventional cigarettes (more harmful, just as harmful, less harmful, do not know) were compared. Descriptive statistics and logistic regressions were performed.Individuals with lower education rated e‑cigarettes as more harmful. Older people and women perceived e‑cigarettes as just as harmful. Smokers considered e‑cigarettes to be more harmful than or just as harmful as conventional tobacco products. The likelihood of using e‑cigarettes for smoking cessation was higher if people thought they were less harmful than conventional cigarettes.Only one-third of the population knows that e‑cigarettes are less harmful to health than conventional cigarettes. The perception of health risks is related to the usage of e‑cigarettes for smoking cessation.

The New Sexual Satisfaction Scale (NSSS) is an internationally established questionnaire for assessing sexual satisfaction. It is based on 2 subscales (ego-centered and partner- and sexual activity-centered sexual satisfaction). The aim of the study was to evaluate the German short version of the questionnaire (NSSS-SD) in a representative sample (N=2524). In addition, relationships between sexual satisfaction and sociodemographic factors (age, sex, education) and characteristics of partnership and sexuality (relationship satisfaction, coitus frequency, number of sexual partners) were examined. The internal consistency of the NSSS-SD was excellent (Cronbach's Alpha = 0.96). The 2-dimensional structure of the long version could not be confirmed for the short version. One factor could be extracted, which explains 68.94% of the variance. An analysis of variance (ANOVA) revealed statistically significant differences in sexual satisfaction with respect to age, education, relationship satisfaction and coitus frequency. Sex and number of sexual partners did not influence sexual satisfaction. The NSSS-SD is a reliable questionnaire of sexual satisfaction for sexually active individuals. For sexually inactive individuals, a change of the instruction or a visual analogue scale might be useful.Die New Sexual Satisfaction Scale (NSSS) ist ein international etablierter Fragebogen zur Erfassung der sexuellen Zufriedenheit mit ursprünglich 2 Subskalen (selbstfokussierte bzw. partner-/aktivitätenfokussierte sexuelle Zufriedenheit). Ziel der vorliegenden Studie war es, die deutsche Kurzversion des Fragebogens (NSSS-SD) im Rahmen einer Repräsentativerhebung in Deutschland (N=2524) zu überprüfen. Zusätzlich wurden Zusammenhänge zwischen sexueller Zufriedenheit und soziodemografischen Faktoren (Alter, Geschlecht, Bildungsstand) sowie Aspekten der Partnerschaft und Sexualität (Beziehungszufriedenheit, Koitusfrequenz, Anzahl der Sexualpartner) untersucht. Die interne Konsistenz der NSSS-SD lag bei 0,96. Die 2-dimensionale Struktur der Langversion konnte für die Kurzversion nicht bestätigt werden. Es konnte ein Faktor extrahiert werden, welcher 68,94% der Varianz aufklärt. Varianzanalysen ergaben signifikante Unterschiede in der sexuellen Zufriedenheit bezüglich Alter, Bildungsstand, Beziehungszufriedenheit und Koitusfrequenz, nicht aber bezogen auf Geschlecht oder Anzahl der Sexualpartner. Die NSSS-SD ermöglicht die Messung der sexuellen Zufriedenheit für sexuell aktive Personen. Für sexuell inaktive Personen sollte eine Änderung der Instruktion in Betracht gezogen oder eine visuelle Analogskala angeboten werden.

In order to protect non-smokers, the federal states of Germany have adopted a law that provides for extensive smoking bans. In many of these federal laws, acute psychiatric facilities are treated as an exception. Therefore, it is often up to the institutions themselves to develop and enforce regulations. The aim of this study was to evaluate the situation in acute psychiatric facilities.The survey was created on the basis of previously evaluated questionnaires and consisted of 53 questions. A total of 289 hospitals were contacted. Participants were invited to take part in the survey via e-mail.59 hospitals (20.4 %) participated in the survey. Binding regulations were in place in 48 (81.4 %) hospitals, in 26 (44.1 %), smoking was prohibited on open wards. Three hospitals (5.1 %) strictly prohibited smoking on locked wards. Stop-smoking medication was available in 31 (55.3 %) hospitals. 19 (32.2 %) offered smoking cessation interventions. 22 (37.3 %) hospitals have set up a working group on the subject.Currently, the issue of smoking in psychiatric facilities does not receive enough attention. The physical and mental health of psychiatric patients would benefit from a smoke-free policy. In order to achieve this, psychiatric staff and patients need appropriate support.Im Zuge der Nichtraucherschutzgesetze wurden in Deutschland weitreichende Rauchverbote ausgesprochen. Die Akutpsychiatrie wird in einigen dieser Ländergesetze als Ausnahme gehandhabt. Somit bleibt es den Einrichtungen mitunter selbst überlassen, diesbezügliche Regelungen auszugestalten und durchzusetzen. Ziel dieser Studie ist es, eine Bestandsaufnahme der aktuellen Nichtraucherschutz-Regelungen in akutpsychiatrischen Einrichtungen zu erstellen.Auf Basis eines bereits evaluierten Fragebogens wurde eine Online Umfrage erstellt, die aus 53 Fragen bestand. Insgesamt wurden 289 Kliniken kontaktiert. Die Teilnehmer wurden via Mail zur Umfrage eingeladen.59 Kliniken (20,4 %) nahmen an der Umfrage teil. Über verbindliche Regelungen verfügen 48 (81,4 %) Kliniken, in 26 (44,1 %) ist das Rauchen auf den offenen Stationen vollständig verboten. In drei Kliniken (5,1 %) gilt absolutes Rauchverbot auf beschützten Stationen. Medikamentöse Unterstützung gibt es in 31 (55,3 %) Klinken. 19 (32,2 %) bieten Tabakentwöhnungsmaßnahmen an. 22 (37,3 %) Kliniken haben einen Arbeitskreis zum Thema eingerichtet.Aktuell wird dem Thema Rauchen in der Akutpsychiatrie noch zu wenig Aufmerksamkeit gewidmet. Die physische und psychische Gesundheit psychiatrischer Patienten würde jedoch von einer restriktiveren Rauchfrei-Politik profitieren. Um diese durchzusetzen, bedarf es einer angemessenen Unterstützung des Personals und der Patienten.

Psychodynamically oriented multimodal therapy approaches are efficacious for outpatients with borderline personality disorder (BPD). Until now, no study has reported the effectiveness, response, and dropout in a psychodynamic oriented multimodal therapy program for inpatients (PDOMT). In this study, we compared the results of 269 individuals seeking a 3-month inpatient treatment with previous studies for BPD inpatients by examining 269 individuals. The Borderline Personality Index (CUT-20-R) was used as the main outcome measure. Therapy outcome was defined in effect size (ES), response, and remission rates. In the pre-post comparison of the CUT-20-R, the ES was 0.74. The response and the remission rates were 34.6% and 2.6%. 50.6% of participants remained unchanged, 6.7% deteriorated, and 27.5% finished treatment prematurely. Male gender and patients with a dependent personality disorder increased the dropout risk. The results suggest that PDOMT might be effective for some, but not all BPD patients. Due to methodological shortcomings of the chosen strategy, future research should examine the effectiveness of PDOMT in a randomized controlled trial.Psychodynamisch orientierte multimodale Therapien haben sich in der ambulanten Behandlung der Borderline-Persönlichkeitsstörung (BPD) als wirksam erwiesen. Bisher hat keine Studie über Wirksamkeit, Response und Drop-out eines psychodynamisch orientierten multimodalen Therapieansatzes im stationären Setting (PDOMK) berichtet. In dieser Studie wurden die Ergebnisse von 269 Patienten, die an einer 3-monatigen stationären Therapie teilgenommen haben, mit Ergebnissen aus früheren Studien verglichen. Als wichtigster Indikator für den Therapieerfolg wurde das Borderline-Persönlichkeits-Inventar (CUT-20-R) herangezogen. Therapieerfolg wurde in Effektstärken (ES) sowie Response- und Remissionsraten ausgedrückt. Im Prä-Post-Vergleich des CUT-20-R betrug die ES 0,74. Die Responserate betrug 34,6% und die Remissionsrate 2,6%. 50,6% der teilnehmenden Patienten zeigten keine Veränderung in ihrer BPD-spezifischen Symptomatik, 6,7% verschlechterten sich und 27,5% beendeten die Therapie vorzeitig. Das Dropout-Risiko war bei Männern sowie Patienten mit einer abhängigen Persönlichkeitsstörung erhöht. Die Ergebnisse sprechen dafür, dass PDOMK bei einigen, jedoch nicht bei allen BPD-Patienten wirksam sein kann. Aufgrund der methodischen Einschränkungen dieser Studie sollten zukünftige Arbeiten die Wirksamkeit von PDOMK in einem randomisiert-kontrollierten Design untersuchen.

Mental disorders are quite common among employees, and cause enormous economic costs. The Salzgitter-Model aims at an early recognition of mental disorders in employees of raw material processing industries by rendering a diagnostic examination (DE), so that appropriate health-care services may be provided promptly.Data of a consecutive sample consisting of 133 mentally ill employees (61% men) were analyzed. Mental disorders were diagnosed using the Structured Clinical Interview for DSM-IV. Moreover, routine data of company health insurance funds collected in the 6 months preceding the DE were evaluated.On average, the DE was conducted 14 days after application. Half the diagnoses were of mood disorders, while almost one third consisted of neurotic, stress-related, and somatoform disorders. For 63% of diagnoses from the DE, a correspondence was found with diagnoses made by practitioners during standard care over the previous 6 months. Of these employees, 42% received drug therapy. However more than one fifth did not receive guideline-based psychopharmacological treatment. Psychological symptoms and work-related factors were the main reasons for utilization of the DE. No employee had received psychotherapeutic treatment prior to the DE; more than 90% accepted the recommendation of treatment after the DE.Strengthened interdisciplinary cooperation can improve the utilization of an employee group that usually does not seek out specific diagnostic examinations and psychotherapeutic treatment.

Infidelity appears to be a common phenomenon. Although there are initially positive consequences for the unfaithful partner, it has negative impacts on individuals, the relationship and health in the long-term. How often are extradyadic sexual contacts indicated within a German sample? Which factors predict infidelity? Via Internet (n=1 899) socio-demographic, individual (attitudes towards infidelity, religiosity), relationship (global and emotional relationship satisfaction, length of primary relationship, sexual agreements), and contextual factors (opportunities) were surveyed. The results of the regression analysis on an 80% subsample (n=1 533) were cross-validated with the remaining 20% of the data (n=366). The analysis showed that 4% of lesbian women, 34% of gay men, 29% of heterosexual women and 49% of heterosexual men reported extra-dyadic sexual contacts. Sexual orientation and restrictive attitudes towards monogamy and infidelity were found to be significant predictors. Low global relationship satisfaction, longer duration of primary relationship, non-monogamous relationships, availability of alternative sexual partners and ways to conceal infidelity increased the likelihood of extradyadic involvement. Cross-validation with 20% of the data (n=366) confirmed the stability of the regression model. Future research should examine identified predictors using representative population-based data. Predictors should be considered in therapy.

Using mean comparisons and effect sizes to report effects of inpatient treatment, this not reveals, how many inpatients benefit from treatment and which characteristics predict the positive outcome. Several characteristics were collected from 1 533 consecutive inpatients with an episode of depression. The pre-post-effect size in the Beck Depression Inventory was 1.29 (95%-CI: 1.23; 1.36). The rate of remission was 39.5%. The rate of response was 57.8% based on the reliable change index (RCI) and 72.4% based on the percental symptom improvement. The regression model with the RCI as outcome variable was stabile in the cross-validation. A negative predictive impact was demonstrated by the depressive symptoms at treatment beginning, whereas higher assessment of physical health and higher level of education were found to be positively associated. A consistent definition of response seems essential for cross-study and cross-methodological comparisons.

Borderline personality disorder (BPD) is considered as the most prevalent personality disorder in an inpatient setting. The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was developed to identify individuals with BPD reliably, valid and economically. To examine the discriminatory ability and diagnostic efficiency of the German version of the MSI-BPD in a sample with patients who meet probable BPD and seek a disorder-related inpatient treatment program. Based on a sample (N=298) containing 178 BPD-patients (60%), the area under the curve was AUC=0.70 (CI 95%: 0.64AUC0.76). Using the preferred cut-off point of7. 84% of individuals with BPD (sensitivity) and 39% of individuals without BPD were identified correctly (specificity). Results suggest that a self-rated screening measure as the MSI-BPD should not be used in a sample with patients who meet probable BPD.

Borderline personality disorder (BPD) is a life-threatening mental disorder. To date, there is no German screening tool available. To examine the psychometric properties of a German version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). A heterogeneous outpatient sample (N=168) was used to examine discriminatory ability, diagnostic efficiency as well as indicators for internal consistency and convergent validity. The area under the curve was AUC=0.90 (CI 95%: 0.85AUC0.96). Using the cut-off point ≥ 7, which corresponds to the maximal Youden-Index, 91% of individuals with BPD (sensitivity) and 80% of individuals without BPD were identified correctly (specificity). The internal consistency was 0.81. Associations with other self-rating measures were found as expected. The German version of the MSI-BPD has demonstrated good psychometric properties for a screening tool.

Background: There is a lack of empirical findings on the transportability of effective psychotherapy interventions and on the prediction of outcome for social anxiety disorder treated in the field. Methods: 131 patients diagnosed with social phobia were treated in a university-based psychotherapy outpatient clinic with a focus on cognitive-behavioral treatments. Techniques applied in individual treatments were identified retrospectively on the basis of patient files and investigated alongside other variables as predictors of treatment outcome. Results: Within-group effect sizes varied between 1.11 and 1.26 for completers, and between 0.64 and 0.81 for the intent-to-treat sample. None of the interventions was delivered according to only one treatment manual and only in 31% was at least three quarters of the treatment based on the same rationale. Most treatments drew on cognitive therapy, exposure therapy, and social skills training. There was a reduced positive effect size for exposure in vivo when compared to other treatment components. Furthermore, lower effect sizes occurred when role-play was implemented in isolation from its origin in behavioral experiments to examine dysfunctional thoughts. Conclusions: Treatment of social anxiety disorder in the outpatient clinic of the TU Braunschweig is effective; however, the effect sizes are below those reported in recent RCTs. The intervention techniques employed are predominantly drawn from different treatment manuals and they do not follow one specific method, as is customary in randomized treatment studies, indicating a discrepancy between services delivered in research versus field settings.

The beneficial effects of Dialectical Behavior Therapy (DBT) for patients with borderline personality disorder (BPD) are well established. However, it is not well known whether this type of treatment relieves symptoms and signs of BPD in the long-term course thereafter and whether the results of DBT are transferable for patients with high comorbidity.We conducted a follow-up examination of 50 consecutive inpatients with BPD as defined by DSM-IV. The patients were examined at admission, at discharge and 15 and 30 months after discharge. For the clinical diagnosis and to survey psychopathology we used the Structured Clinical Interview for DSM-IV (SCID), the Global Assessment of Functioning (GAF) and several self-rating-instruments.Compared to admission 30 months after discharge we observed the following results: A significant number of patients did not meet the DSM-IV criteria for BPD anymore, comorbidity (particularly mood disorders, drug or alcohol abuse/dependence and eating disorders) was reduced, psychosocial functioning was improved and general and BPD-typical symptoms were relieved.Our findings support the efficacy of DBT in an inpatient setting and show that the achieved success of therapy is stable for a prolonged period of time. Patients with high comorbidity seem to profit from DBT as well.