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Objective: To identify factors influencing the subjective assessment of patients regarding the outcome of in-patient psychotherapy for anxiety disorders., Methods: A total of 231 patients were tested at admission, discharge and 1-year follow-up in a multi-center study. Subjective outcome assessment was measured with the revised German version of the Helping Alliance Questionnaire. The use of the term "outcome satisfaction" is discussed., Results: Patient outcome assessment did not correlate with age, sex, or education, or with duration or severity of illness or duration of treatment. Outcome assessment was closely connected with therapy success. Reaching a low symptom level ("clinical significance") had a higher impact than a high pre-post-difference ("statistical significance")., Conclusions: Anxiety patients give a generally positive assessment of their therapy outcome, which is most determined by symptom-related treatment success. The differentiation of "clinical" and "statistical significance" of success is of importance for the patient's subjective view of the therapy outcome.

This paper reflects the thinking, experience as well as diagnostic and therapeutic strategies of the Gelderland specialized clinic for psychotherapy and psychosomatic medicine with regard to extrinsically motivated patients, i.e., patients "sent" for treatment. The objective is to develop a therapeutic concept and to establish guidelines concerning the sociomedical aspects to be taken into account in this patient group. The problem analysis should start out at the situation at hand initially: Not only do these patients as a rule refuse to take an active part in therapy; they all to often attempt to sabotage any rehabilitation offers perceived as running counter to their own desires and goals (e.g. pension, retraining, collection of benefits during illness-related unemployment, etc.). Attempts to elucidate the psychosomatic problem complex of these patients are in addition hampered by their predominantly body-centred concept of disease. The particular motivational and therapy-related features of these patients are illustrated by case studies. A standardized procedure for sociomedical performance appraisals is presented which takes the specific features of this patient group into account and has stood the test in the clinical setting. Special mention should be made of: pre-admission diagnostics, inpatient psychodiagnostics, multidisciplinary systematic behavioural observation of the patient in the framework of group therapy, and a sensitive approach to conveying diagnostic results to the patient. The double role of psychotherapist and appointed expert is one demanding the highest degree of professional expertise. Besides, the expectations of the social security and financially responsible agencies which "sent" the client have to be taken into account as well. The sociomedical evaluation serves as the starting point for all therapeutic efforts and identification of the extent of a patient's extrinsic motivation. Along with a thorough review of the patient's medical records, pre-admission diagnostic efforts are in place in this respect for assessing a patient's motivation for therapy.

Studies undertaken in the scientific area of general systems theory generally seek to elucidate central interrelationships. This paper its no exception in that it presents a "general model of psychosomatic rehabilitation". This new Y-shaped model was inspired firstly by the "general model of psychotherapy" and secondly by general systematic considerations on medical rehabilitation. It was first used to assess the progress of patients undergoing inpatient psychosomatic rehabilitation and to determine the relationship between treatment intensity and length of time-sensitive psychotherapy.

To provide optimal medical care for patients with psychosomatic disorders, rehabilitation and acute medicine should be viewed as separate but related parts of one overall health care concept. Psychosomatic rehabilitation now plays a major role in the care of chronically ill patients beyond the framework of traditional medical psychotherapy. The self image and rehabilitative concepts of this field are strongly influenced by two cornerstones of psychotherapy: psychodynamics and behavioral science. In the past the main factors used to define requirements for inpatient care were the capacity of existing facilities and the degree of their utilization; what was and still is lacking is an expert assessment of real demand. By offering programs for a broad spectrum of chronic disorders, the field of psychosomatic rehabilitation has achieved impressive therapeutic results at moderate cost; this assertion is substantiated by numerous analyses of the health care system. However, the high quality standard in the field of psychosomatic rehabilitation is currently endangered by politically motivated economic measures and the accompanying reduction of therapy time. If this counterproductive trend is not halted, the inevitable outcome will be suboptimal--in particular for chronically ill patients. In conclusion, possibilities are outlined for improved networking among professionals in psychosomatic rehabilitation.

Results of an analysis are presented, concerning the situation of animal welfare in keeping and housing of calves, pigs and laying hens. It is observed, that stockholders are making great efforts to follow the animal welfare regulations. Remaining problems of animal welfare in farms are described.

By means of a thermo exchange apparatus it is possible to recover 70 to 80 percent of warmth of the stable air for heating. Thus much energy for climatizing can be saved. Alternating directions of to and from air streams may cause re-influx of germs, dependent on percentage of dust. This risk can be minimized by using an apparatus each for relatively small units separately.

The following study examines the correlation of psychosocial stress and disease activity in patients suffering from chronic inflammatory bowel diseases. 70 patients with Crohn's disease and 44 patients with ulcerative colitis took part in this study. Using an inventory for the registration of life-changing events, psychosocial life-events of the last 24 months were inquired. The disease activity was registered by an activity index created for this particular purpose. Due to the formulation of the question, pure subjective data were not considered. With regard to the social data, the two samples can very well be compared with other epidemiological studies. For the group of Crohn-patients, a significant correlation between psychosocial stress and a subsequent increased disease activity was demonstrated. Surprisingly, the group of patients with ulcerative colitis did not show this correlation.

Symptom Validity Testing was developed to evaluate complaints of sensory deficits. The assessment is based on the inability of patients to perceive a sensory signal. Subjects must guess the signal using the model of coin flipping (head or tail). The signals are presented randomized in an equal number of alternatives. A 50-percent hit-rate for enough trials is expected in a true sensory deficit. Deceptive patients are expected to perform a hit-rate below the probabilities of chance.

In three women intoxication with vitamin D or dihydrotachysterol occurred. Two patients died from complications despite successful lowering of the serum calcium, the third died after a pulmonary embolus during hypercalcaemia 5 months after cessation of vitamin D. Correct observation of the narrow therapeutic range of vitamin D preparations appears most important in the treatment of hypoparathyroidism and other indications. Particular attention should be given to the prophylaxis of over dosage. Apart from regular serum calcium estimations instruction of the patient and relatives as to the dangers and symptoms of intoxication is recommended. The issuing of a therapy identity card would meet these requirements.

Tinnitus patients often complain of psychosomatic disorders and of problems in social life. We intended to prove the modulation of tinnitus perception by psychosocial factors. We examined 48 tinnitus patients, 35 with and 13 without hearing loss. A control group of 48 patients without tinnitus, without hearing disorder and without tumor disease was adapted to correspond to the tinnitus group in respect of age, sex and social factors. A quantitative assessment of complaints as well as of the intensity of depression was made via questionaires (Giessener Beschwerdebogen and Beck Depression Inventory). In tinnitus patients, we found a statistically significantly higher degree of complaints even for non-otological symptoms. They were statistically more depressive than the controls, but less than patients with endogenic depression usually are. Nevertheless, in tinnitus patients it seems to be reasonable to inquire after general symptoms of illness to assess whether cooperation with a psychiatrist is required before initiating somatic treatment.