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Introduction: Advice literature on depression for patients and their relatives is a widespread and low-threshold source of information. In terms of empowerment of the patients it can contribute to the early detection and effective treatment of the disorder. An evaluation of its content quality, particularly its evidence base, is still missing. Considering this, the content of advice literature on depression is reviewed by comparing it systematically with content and recommendations from the German S3-/NV-guideline on unipolar depression., Methods: Based on a systematic search within the data base of the book trade, the 30 most widespread German advice books were analysed. For this purpose a rating instrument (RLP-D) with 54 items on diagnostics and treatment was derived from the current S3-/NV-guideline. With the help of the RLP-D one rater analysed both elaboration and accuracy of the 30 books' content., Results: Between 7.4 and 81.5% of the items i. e. of the guideline content, are missing in the analysed advice books (Mdn=25.9%, IQR=22.7%). On average a third of the 54 items is covered extensively as well as without contradictions to the guideline (Mdn=36.1%, IQR=17.1%, Range: 1.9-64.8%). A fifth of the covered items (Mdn=20.4%; IQR=19.0%, Range: 2.9-47.6%) shows clinically relevant contradictions to the guideline content. Information about psychotherapy and pharmacotherapy as treatment options is the content which is covered extensively and correctly most often: The information is given in more than 83% of the books., Discussion: There is a substantial variability concerning the elaboration and accuracy of the diagnostics and treatment content in advice literature. This also applies to the especially concerning erroneous content in advice literature. The further evaluation of the rating instrument RLP-D is a next important step. An application and reduction to the core contents of the guideline could facilitate the currently rather complex and laborious rating system., Conclusion: Although some basic information is given in almost all of the analysed books, advice literature on depression cannot be recommended per se due to the large differences in quality. Systematic evaluations of quality should be established in order to facilitate a well-grounded choice of literature in order to improve the information for patients., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Body Dysmorphic Disorder: Diagnosis, Treatment and Challenges in the General Practice Abstract. Body dysmorphic disorder (point prevalence: 1.7-2.4 %) is characterized by excessive preoccupation with one or more subjectively perceived blemishes of the appearance, as a result of which those affected show a high burden of disease due to avoidance behavior and time-consuming rituals, and often secondary problems (including depression, suicidal tendencies). The disorder is often accompanied by pronounced shame and is therefore associated with challenges in diagnostics, which is why the indication and specialist treatment (first-line treatment: cognitive-behavioural therapy) are usually only carried out with great latency. Family doctors can play a key role in diagnosis and treatment because of the often long-standing relationship of trust with their patients. Targeted screening, active and at the same time prudent discussion, as well as knowledge of treatment options and special features of the disease pattern (e.g. fluctuating understanding of the disease, desire for plastic surgery measures) are necessary. Against this background, the article provides an overview of the clinic, diagnostics and therapy and concludes with specific challenges and practical recommendations for family practice.

Objective: Which health care barriers do patients with anxiety and depressive disorders experience on their clinical pathways?, Methods: Semi-structured interviews were conducted among 30 patients with anxiety and depressive disorders. Interviews were audio-taped, transcribed, coded and content-analysed., Results: Following barriers perceived by patients were extracted: a lack of early diagnosis, communication and coordination problems between different services and providers, little information about their illness and its adequate treatment, as well as intrapersonal barriers., Conclusions: Patients perceive barriers on the individual, provider and system level. Especially barriers on the system and provider level indicate a need for more information, early recognition and support especially during the help-seeking process., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Evaluation of satisfaction and acceptance of a stepped care model in the Health Network Depression from the perspective of general practitioners, psychotherapists and psychiatrists., Methods: Cross-sectional questionnaire study with n = 61 care providers., Results: All elements of the stepped care model, e. g. screening, diagnostic, and monitoring checklists, guidelines, low-intensity treatment options and IT-tools were utilized by over 75 % of partners and obtained largely positive ratings., Conclusion: This positive evaluation provides a basis for further participative development and transfer into health care., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Depression is one of the most widespread mental disorders in Germany and causes a great suffering and involves high costs. Guidelines recommend stepped and interdisciplinary collaborative care models for the treatment of depression., Objectives: Stepped and collaborative care models are described regarding their efficacy and cost-effectiveness. A current model project within the Hamburg Network for Mental Health exemplifies how guideline-based stepped diagnostics and treatment incorporating innovative low-intensity interventions are implemented by a large network of health care professionals and clinics., Materials and Methods: An accompanying evaluation using a cluster randomized controlled design assesses depressive symptom reduction and cost-effectiveness for patients treated within "Health Network Depression" ("Gesundheitsnetz Depression", a subproject of psychenet.de) compared with patients treated in routine care., Results: Over 90 partners from inpatient and outpatient treatment have been successfully involved in recruiting over 600 patients within the stepped care model. Communication in the network was greatly facilitated by the use of an innovative online tool for the supply and reservation of treatment capacities. The participating professionals profit from the improved infrastructure and the implementation of advanced training and quality circle work., Conclusions: New treatment models can greatly improve the treatment of depression owing to their explicit reference to guidelines, the establishment of algorithms for diagnostics and treatment, the integration of practices and clinics, in addition to the implementation of low-intensity treatment alternatives. These models could promote the development of a disease management program for depression.

Objective: As an initiative of the German Pension Insurance Association (DRV), evidence-based therapeutic modules (ETM) for the rehabilitation of patients with depression were developed. The objective of the subsequent analysis was to analyse the therapeutic procedures in inpatient rehabilitation on the basis of the ETM to evaluate the principal needs for therapeutic standards., Methods: Data based on the German Classification of Therapeutic Procedures (KTL) for 21 529 patients treated in rehabilitation clinics for people with mental illnesses was analysed with respect to differences between diagnostic groups/clinics regarding type, quantity and duration of measures coded., Results: The mean quantity and duration of the interventions for patients with depressive disorders encoded varied greatly between the ETM. No or only minor differences were found between patients with depression and those with other diagnoses regarding the type, quantity and duration of measures coded. However, there were great variances between clinics., Conclusions: Therapeutic standards for rehabilitative practice appear necessary in order to reduce treatment heterogeneity between rehabilitation facilities, which could improve the quality of healthcare., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Breast cancer patients are as a rule in need of a multiple sequential in-patient, day-patient and out-patient permanent treatment. The required care demands a trans-sectoral networking of all multi-professional persons involved in diagnostics, therapies, rehabilitation and aftercare. A method to develop the integration of treatment processes, as well as thereby resulting in increased effectiveness and efficiency, can constitute the concept of case management. A prerequisite for an effective implementation of case management and thus the starting point of the present survey is a well-functioning network encompassing optimal cooperation. Within the framework of the evaluation of the case management-based integrated care model "mammaNetz" for women with mamma carcinoma as a whole and against the background of the potential for innovation and improvement of case management on the one hand as well as the existence of only few empirical data otherwise, the present survey of members of a trans-sectoral network of the service centre was accomplished., Method: Medical and non-medical networking partners of the service centre (N=168) were questioned by regular mail about different aspects of the cooperation. Identical items in both surveys were compared., Results: The return rate for the medical networking partners is about 59% (n=35), whereby only medical network partners in private practice participated in the survey. For the non-medical networking partners about 60% (n=66) participated. Medical networking partners assess the cooperation with the service centre in reference to the exchange of information slightly more positively (66%) than the non-medical networking partners (59%). Medical networking partners are in significantly more frequent contact with the service centre and see in the cooperation significantly more advantages for their own office/facility (each with p=0.001) than non-medical networking partners. Overall the results suggest that medical as well as non-medical networking partners consider the functioning and the methodical concept of the service centre to be reasonable., Conclusion: The implementation of an interdisciplinary process of support for patients with mamma carcinoma necessitates a good cooperation between networking partners, case managers and patients. Within the framework of a follow-up survey with the objective of a deeper process evaluation, non-medical networking partners should be divided into further professional specific subcategories. In this manner interventions that are fitted to specific occupational groups can be derived., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: In recent years, the importance of guidelines has increased continuously. This development also occurs in the field of rehabilitative health care, where process guidelines are being designed for various indicational groups to ensure quality standards and improvements., Aim: The primary goal of this paper is to collect and evaluate the evidence for various treatment options for depressive disorders in order to establish a basis for the current development of a process guideline for the rehabilitation of patients with depressive disorders., Method: In order to identify evidence based treatment elements, first a comprehensive investigation of national and international guidelines was conducted. Thirteen selected guidelines were then assessed with regard to aspects of methodological quality and evidence-based treatment elements. In a further step, literature searches were conducted for residual treatment elements, which were identified on the basis of the Classification of Therapeutic Services (KTL) 2007. For the literature search, a hierarchical approach was chosen: At first, meta-analyses and systematic reviews were viewed. In case when there was still a lack of evidence for specific, potentially relevant treatment elements, the search was expanded to the level of primary studies. All selected reviews and primary studies then underwent a standardized assessment especially regarding methodological quality and evidence grades were allocated to treatments., Results: Thereby, the following treatment elements with an adequate level of evidence were identified: Psychotherapeutic interventions, marital/couples/family therapy and counselling, inclusion of family members, psycho education and exercise, problem solving therapy, guided self-help, and behavioural activation treatments. On the basis of this complementary literature search, various other evident interventions could be identified within the following areas: relaxation techniques, improvement of social competence, occupational therapy, art therapies (music, movement/dance therapies), body-oriented therapies and massage therapy., Conclusion: In summary, using this hierarchical approach, it was possible to assign different levels of evidence to the various treatment elements for depression. Based on the results of this literature search, a next step in the development of a process guideline for the rehabilitative treatment of patients with depression will be the integration of experts in the field of rehabilitation., (Georg Thieme Verlag KG Stuttgart.New York.)

Objectives: In a systematic literature review we examined patient-related predictors of inpatient treatment duration for mental disorders., Methods: The databases Medline, Embase, Psyndex, PsycINFO and EBMR were systematically reviewed for studies in the years 1990-2009 regarding treatment duration of inpatients with ICD-10 diagnoses F3-F6. Also, their methodological quality was evaluated., Results: Twenty-one studies examining 28 predictors (sociodemographic, clinical) were included. Longer treatment durations were found for patients living alone and with higher levels of initial symptom severity, duration of mental disorder, number of previous treatments, work absenteeism, and comorbidity. Obsessive-compulsive, eating and personality disorders were treated longer than depressive, anxiety, somatoform, and adjustment disorders. Results for age, gender, education, and profession were inconsistent., Conclusions: The studies included heterogeneous analyses, treatments, and patients. Despite their sufficient methodical quality, these results are only tentative.

In the current discussion on optimizing psychotherapeutic approaches, two important developments have to be considered: a tendency towards integrative and a tendency towards disorder specific approaches. For the years 2005 and 2006, an analysis of three German journals (covering the fields of psychosomatics, psychiatry and clinical psychology) was conducted on the question whether these two developments can be identified in current empirical and conceptual publications. Contrary to the expectations, there are only very few papers dealing with integrative approaches. As expected, there is a major emphasis on psychodynamic and cognitive behavioural approaches; other approaches are only marginally considered. A disorder specific approach can be identified not only for cognitive behavioural, but also for psychodynamic papers.

Since cognitive behavioural (CBT) and psychodynamic (PDT) approaches treat patients with comparable disorder spectrums, yet at the same time show very different fundamental concepts, training modalities and treatment rationale, a comparison of the process and outcome of these methods becomes particularly significant. The present article offers an overview of the significance of comparative process research as well as of the theoretical and, in particular, the empirical knowledge concerning the difference between CBT and PDT at the process level (therapeutic interventions, contents and styles). Results show that CBT and PDT display pronounced differences in a broader spectrum of process variables not only on the basis of their theoretical conceptions but also referring to empirical data. While at least within the framework of experimental designs the general result of different profiles can be considered robust, statements concerning the actual treatment practice and clinical routines can only be made on a very isolated basis due to a lack of naturalistic studies. The need for research which can be derived from this, as well as further necessary developments in the field of comparative process research are discussed.

The following article presents aspects of the field of psychosocial medicine in Germany from the perspective of health services research. First, the tasks and topics of health services research are listed. The identification and appropriate treatment of people with mental disorders is one of the core themes of psychosocial health care; therefore, a brief overview of research results on the epidemiology of mental disorders is first presented. The primary focus of this article is then to provide a description and analysis of the structures of psychosocial care in inpatient and outpatient settings. Research findings concerning treatment processes and the result of these processes are additionally presented. The findings show that there is still a considerable lack of research results regarding the treatment of patients with mental disorders, as is also the case in other health care areas. An important empirical basis for rationally founded treatment planning in this area is thus lacking.

Objective: In the context of the current discussion of integrating rehabilitative elements into the (acute) treatment of patients with mental disorders, it is investigated what rehabilitative elements actually are and whether these elements are considered in existing guidelines., Methods/results: An expert-based consensus, especially results of expert ratings using a 46-item questionnaire (Delphi Technique; n = 16), shows that it is possible to specify rehabilitative elements, although there are still aspects which need further clarification. Analyses of current guidelines (using published guidelines for panic disorders) demonstrate that rehabilitative elements which are rated as important by the experts are only marginally mentioned in guidelines up to now., Conclusions: A considerable need for research exists for a further specification of rehabilitative elements and for the development of evidence based recommendations in the form of guidelines.

It is becoming increasingly more relevant for health care providers to also participate in external quality assurance measures. A few systematic approaches that also integrate outcome quality and include a comparison of different clinics have only recently been developed for the area of the treatment of patients with mental disorders. In this context, a key issue is the appropriate consideration of confounders, i.e., of unevenly distributed patient characteristics that are causally related to the treatment results. Using a sample of consecutive patients from four psychotherapeutic clinics, we exemplarily examined the significance of the confounders for the comparison of the clinics with regard to short-term outcome. The results show that an adjustment is principally advisable and is generally associated with a reduction of the differences in treatment results. The discussion asserts that the use of regression weights, which were ascertained using an independent, representative sample, allows for a more valid risk adjustment. Finally, reference will be made to the relevance of giving consideration to varying resource usage in the assessment of the risk-adjusted clinic comparisons.

Research concerning the question, whether and to what extent cognitive-behavioral (CB) and psychodynamic (PD) therapy consist of differing process components under clinical representative conditions, is relevant especially for a valid interpretation of comparative outcome research, for identifying differential beneficial factors of psychotherapy and for a systematic indication for, respectively assignment of, patients to the two treatments. In this study it is investigated whether PD and CB differ concerning the realisation of factors of group experience, respectively of beneficial group elements (e. g. cohesion, catharsis, learning by feedback). For this purpose, in a naturalistic design, a stratified sample (N = 36) of 104 videotaped sessions (PD groups, interactional CB groups and indicative CB groups; N = 171 patients with a broad spectrum of F-diagnoses of ICD-10, especially F3/F4) were rated by observers using the Kieler-Gruppenpsychotherapie-Prozess-Skala (KGPPS). Analyses of variance and a priori Helmert-contrasts reveal differences between PD and CB with at least medium effect sizes in 12 of the 16 factors of group experience. However, differences also were found between the two CB group treatments (9 factors of group experience with differences with large effect sizes). The results suggest that the different treatment approaches foster different qualities and quantities of group experience and that the latter seems not to evolve from the group context "per se" (i. e. by the plurality of the group).

Objective: Recent research on predictors of resource use in inpatient psychotherapy indicates that various patient characteristics as well as therapeutic factors may influence resource use. The aim of our study was to examine the relationship between patient attributes and psychotherapeutic costs in German inpatient psychotherapy. The amount of variance explained in resource use was calculated., Method: The existing sample used in this study consists of sociodemographic and clinical variables of 2375 patients treated in various inpatient psychosomatic clinics. Resource use was measured on the basis of clinical staff activities (Klassifikation Therapeutischer Leistungen, KTL, BfA 2000). Regression Tree Analysis was performed to classify patient attributes based on resource use., Results: The model assigns patients to 20 classes, accounting for 17.5 % of variance. Those patients with single status and personality or eating disorder consume more resources than those patients with non-single status, low motivation for psychotherapy, comorbidity of physical illness and lower levels on symptom severity., Conclusions: Implications of the results for the development of a patient classification system in inpatient psychotherapy will be discussed.