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This study investigated the relationship between meaning in life and coping with trauma, and correlations between posttraumatic growth and mental health.The content and structure of the personal meaning systems of 62 patients suffering from posttraumatic stress disorder (PTSD) were assessed qualitatively. In addition, the participants completed questionnaires measuring meaning in life (LRI-r-d; MLQ), PTSD symptoms (IES-R), depression (BDI-II), health-related quality of life (EQ-5D), satisfaction with life (SWLS) and posttraumatic growth (PPR-r).A stronger sense of meaning in life and a more elaborately structured personal meaning system correlated with a better mental health and more posttraumatic growth. Posttraumatic growth was also associated with mental health.Patients with coherent personal meaning systems are more successful in coping with traumatic life events. They also reported more posttraumatic growth.

This study investigated the changes in attachment characteristics of patients undergoing inpatient group psychotherapy in routine care. We collected data from 265 consecutively recruited patients and 260 non-clinical control persons using self-report measures of attachment, depression, and socio-demographic characteristics. The effects of treatment on patients were analyzed using propensity score techniques (propensity strata and logit-transformed propensity scores) in combination with a generalized analysis of covariance. A moderate increase of attachment security was found which could be attributed to a decrease both in attachment anxiety and avoidance. Pre-post improvements in attachment with regard to romantic partnerships were stable after a 1-year follow-up. Furthermore, we found significant treatment-covariate interactions indicating that subjects with particularly high treatment propensities (propensities were highly correlated with depression and attachment anxiety) improved the most in terms of attachment security. Our results are encouraging for psychotherapeutic practice in that they provide evidence that long-term attachment improvements can be reached via psychotherapy. Our results will also provide a sound basis for future studies in the field of clinical attachment research, e.g., studies examining whether improved attachment security is correlated to symptom improvements in different psychological disorders.

Background Psychodynamic psychotherapy is frequently applied in the treatment of social phobia. Nevertheless, there has been a lack of studies on the transfer of manualized treatments to routine psychodynamic practice. Our study is the first one to examine the effects of additional training in a manualized Short Term Psychodynamic Psychotherapy (STPP) procedure on outcome in routine psychotherapy for social phobia. This study is an extension to a large multi-site RCT (N = 512) comparing the efficacy of STPP to Cognitive-Behavioral Therapy (CBT) of Social Phobia. Methods/Design The manualized treatment is designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners will be randomized to training in manualized STPP vs. treatment as usual without a specific training (control condition). We plan to enrol a total of 105 patients (84 completers). Assessments will be conducted before treatment starts, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 months and 12 months after termination of treatment. The primary outcome measure is the Liebowitz Social Anxiety Scale. Remission from social phobia is defined scoring with 30 or less points on this scale. Discussion We will investigate how the treatment can be transferred from a controlled trial into the less structured setting of routine clinical care. This question represents Phase IV of psychotherapy research. It combines the benefits of randomized controlled and naturalistic research. The study is genuinely designed to promote faster and more widespread dissemination of effective interventions. It will answer the questions whether manualized STPP can be implemented into routine outpatient care, whether the new methods improve treatment courses and outcomes and whether treatment effects reached in routine psychotherapeutic treatments are comparable to those of the controlled, strictly manualized treatment of the main study. Trial Registration German Clinical Trials Register (DRKS) DRKS00000570

This study investigated differences in the personal meaning systems of psychotherapists and psychotherapy patients as well as correlations between meaning in life and mental health.We qualitatively assessed the content and structure of the personal meaning systems of 41 psychotherapists and 77 psychotherapy patients. In addition, the participants completed questionnaires measuring meaning in life (LRI-r-d), sense of coherence (SOC-9L), self-esteem (RSES), satisfaction with life (SWLS), self-efficacy (SWK), and depression (BDI).The personal meaning systems of psychotherapists were more complex and coherent compared to psychotherapy patients. In the group of psychotherapy patients, a more elaborate structure of the personal meaning system correlated with the subjective sense of meaning. We were able to confirm correlations between meaning in life and mental health for most of the instances.Psychotherapists had more elaborate and coherent meaning systems than psychotherapy patients. Especially for psychotherapy patients elaborate and coherent meaning systems turned out to be important for mental health.

Adjustment disorders (AD) represent a frequently diagnosed type of disorder for which scientific interest has been limited because of insufficient diagnostic criteria. This study presents a concept comprising cognitive, behavioural, and emotional criteria (ADNM) which investigates differences in symptom severity, willingness to change, and motivation for psychotherapy in subjects with adjustment disorders.331 outpatients were examined with a number of tools (ADNM, SCL-90-R, FPTM-23, FEVER). The ADNM is evaluated on the basis of theoretical assumptions and divides the sample into subjects with elevated and normal scores.The sample comprised patients with elevated scores (61%) and normal scores (39%).Subjects with AD scored higher on depression, anxiety, and impulsivity as well as exhibiting elevated scores on the SCL-90-R, for contemplation/action, and for psychotherapy motivation.The ADNM identifies patients experiencing stress. Further longitudinal studies should examine whether patients more frequently enter psychotherapy or not.

Background The aim of this study was investigating how women with a history of childhood maltreatment (CM) process non-threatening and non-trauma related olfactory stimuli. The focus on olfactory perception is based on the overlap of brain areas often proposed to be affected in CM patients and the projection areas of the olfactory system, including the amygdala, orbitofrontal cortex, insula and hippocampus. Methods Twelve women with CM and 10 controls participated in the study. All participants were, or have been, patients in a psychosomatic clinic. Participants underwent a fMRI investigation during olfactory stimulation with a neutral (coffee) and a pleasant (peach) odor. Furthermore, odor threshold and odor identification (Sniffin' Sticks) were tested. Principal Findings Both groups showed normal activation in the olfactory projection areas. However, in the CM-group we found additionally enhanced activation in multiple, mainly neocortical, areas that are part of those involved in associative networks. These include the precentral frontal lobe, inferior and middle frontal structures, posterior parietal lobe, occipital lobe, and the posterior cingulate cortex. Conclusions The results indicate that in this group of patients, CM was associated with an altered processing of olfactory stimuli, but not development of a functional olfactory deficit. This complements other studies on CM insofar as we found the observed pattern of enhanced activation in associative and emotional regions even following non-traumatic olfactory cues.

Childhood maltreatment (CM) as well as posttraumatic stress disorder (PTSD) is said to result in functional changes to amygdalae and orbitofrontal cortex. Thus, it might be expected to change olfactory function in adults with a CM-history and current PTSD symptomatology as amygdalae and orbitofrontal cortex are of major importance for olfactory information processing. To explore this we investigated olfactory function in 31 women with current psychopathology and a history of CM, 28 without CM, and 27 healthy women. We used the "Sniffin' Sticks" threshold and identification test and analyzed chemosensory event-related potentials. Participants were also asked to complete a questionnaire to access current symptoms of posttraumatic stress disorder (PTSD). We found no significant difference between the CM-Group and the two control groups, but PTSD severity correlated significantly with odor identification scores and with parameters of event-related potentials in response to unpleasant stimuli. The results indicate preferential processing of unpleasant stimuli in PTSD patients irrespective of the childhood history.

Anecdotal reports from patients with smell loss provided the basic motivation for the present study on sexual dysfunction among patients with olfactory dysfunction. The aim of the present study was to investigate the sexual appetite and the subject's depression in regard to olfactory function.Eighty-six patients referred to our smell and taste clinic with olfactory dysfunction were investigated. Olfactory function was assessed by means of the "Sniffin' Sticks" test battery consisting of tests for odor threshold (T), odor discrimination (D), and odor identification (I). Their results were summed up to a composite score, the so-called "TDI score." All participants completed a questionnaire including the Beck Depression Inventory (BDI) and 11 questions for evaluation of the sexual appetite in regard to the time before the onset of olfactory dysfunction and since the olfactory dysfunction. The points received for the latter questions were summed up to the so called Sexual Appetite Index (SAI).Olfactory testing revealed that 38 patients were functionally anosmic, 39 patients were hyposmic, and nine patients were normosmic. The average BDI score was 11.0 +/- 8.4 points. Evaluation of the SAI questionnaire revealed a significant decrease (P = 0.003) of the score from 22.7 +/- 4.5 points from the time before to 21.4 +/- 4.9 points since the onset of olfactory loss. No significant correlation was found between olfactory function and the SAI since the onset of olfactory dysfunction. However, the BDI score correlated negatively with the SAI since the onset of olfactory dysfunction (r(85) = -0.36; P = 0.001).The present study does not confirm the hypothesis that loss of olfactory function directly impacts on sexual appetite. It seems that depression caused by olfactory loss is the main cause for the self-reported decrease in sexual appetite as the onset of olfactory dysfunction.

Background Ethnic diversity in schools increases due to globalization. Thus, the children's social-emotional competence development must be considered in the context of a multi-ethnic classroom. Methods In this study, the social-emotional competence of 65 Asian-American and Latin-American children was observed at the beginning and the end of their kindergarten year. Results Initially, significant differences existed among these ethnic groups in respect to moral reasoning. Furthermore, the male children showed more dysregulated aggression but the female children implemented more moral reasoning than their male counterparts. These ethnic specificities did not disappear over the course of the year. In addition, a significant change in avoidance strategies as well as expressed emotions in the narrative took place over the course of one year. Conclusion Ethnic specificity in social-emotional competence does exist independent of gender at the beginning as well as at the end of the kindergarten year in a multi-ethnic kindergarten classroom.

This paper presents the Social Phobia Psychotherapy Research Network (SOPHO-NET). SOPHO-NET is among the five research networks on psychotherapy funded by "Bundesministerium für Bildung und Forschung". The research program encompasses a coordinated group of studies of social phobia. In the central project (Study A), a multi-center randomized controlled trial, refined models of manualized cognitive-behavioral therapy (CBT) and manualized short-term psychodynamic psychotherapy (STPP) are compared in the treatment of social phobia. A sample of n=512 outpatients will be randomized to either CBT, STPP or wait list. For quality assurance and treatment integrity, a specific project has been established (Project Q). Study A is complemented by four interrelated projects focusing on attachment style (Study B1), cost-effectiveness (Study B2), polymorphisms in the serotonin transporter gene (Study C1) and on structural and functional deviations of hippocampus and amygdala (Study C2). Thus, the SOPHO-NET program allows for a highly interdisciplinary research of psychotherapy in social phobia.

Background: Subtle and inconsistent differences in hypothalamic-pituitary-adrenal (HPA) axis activity have been reported for patients with panic disorder. While these patients show little or no alterations in basal ACTH and cortisol levels, it has been hypothesized that HPA hyperresponsivity was a trait in panic patients when exposed to novel and uncontrollable stimulation. Methods: Thirty-four patients (23 females, mean age 35 yrs) diagnosed with panic disorder were compared to 34 healthy controls matched for age, gender, smoking status, and use of oral contraceptives. Both groups were exposed twice to a potent laboratory stress protocol, the Trier Social Stress Test (TSST) on consecutive days. Free salivary cortisol levels and heart rate responses were repeatedly measured before and following the TSST. In addition, the cortisol awakening response (CAR) was assessed to further investigate HPA reactivity in PD patients. Results: While the TSST induced similar heart rate stress responses in both groups, cortisol responses were clearly absent in the panic patients with normal responses in the controls (F(1.96, 66) = 20.16; p < 0.001). No differences in basal cortisol levels were observed in the extended baseline period. The same cortisol stress non-response patterns were observed when patients with/without comorbid depression, or with/without psychotropic medication were compared. In contrast to their non-response to the psychosocial stressor, panic patients showed a significant CAR. Conclusion: These findings provide strong evidence to suggest that PD patients present with a striking lack of cortisol responsivity to acute uncontrollable psychosocial stress under laboratory conditions. This unresponsiveness of the HPA axis appears to be rather specific, since a normal CAR in the morning could be documented in these patients. Thus, the present results do not support the hypothesis that PD patients show a trait HPA hyperresponsiveness to novel and uncontrollable stimulation. In contrast, the data provide support for a hyporesponsive HPA axis under emotional stress in PD patients.

Depressive Storungen sind in der psychosomatischen Akutversorgung eine haufige Erkrankung. Der Anteil der Patienten, die an einer Depression oder einer klinisch relevanten Auspragung der Depressivitat leiden, liegt in der untersuchten Stichprobe bei 67%. Auf der Basis des Merkmals Depressivitat wurden clusteranalytisch funf Verlaufstypen identifiziert: Patienten mit masig ausgepragter, kontinuierlich abnehmender Depressivitat (Cluster 1, n = 80, 41.2%), Patienten mit hoher Depressivitat und kontinuierlicher, stabiler Verbesserung (Cluster 2, n = 41, 21.1%), Patienten mit hoher, stabiler Depressivitat (Cluster 3, n = 32, 16.5%), Patienten mit masiger Depressivitat und instabiler Verbesserung (Cluster 4, n = 28, 14.4%) sowie Patienten mit starken Schwankungen in der Depressivitat (Cluster 5, n = 13, 6.7%). Die Analyse von Pra- (Komorbiditat, seelische Gesundheit, relevante Problembereiche) und Post-Differenzen (Zielerreichung und Problemverbesserungen am Ende der Therapie und ein Jahr spater) zeigte, dass Patienten in Cluster 1 sich deutlich von den anderen Gruppen unterschieden. Sie waren weniger belastet (Depressivitat, Komorbiditat) und seelisch gesunder. Ihr Therapieerfolg (Zielerreichung und Problemreduktion) war groser. Die erzielten Therapieergebnisse blieben im Katamnesezeitraum nicht in allen Patientengruppen stabil. Ein groser Teil der Patienten (Cluster 1 und Cluster 3, n = 121) konnte das erzielte Therapieergebnis halten, in zwei Gruppen (Cluster 4 und Cluster 5, n = 41) kam es allerdings im Vergleich zum Therapiebeginn zu einem deutlichen Anstieg der Depressivitat. Die Ursachen dafur sind moglicherweise negative Therapieeff ekte (Cluster 5) und Ruckfalle und soziale Probleme im Katamnesezeitraum (Cluster 4). Offen bleibt, was die unterschiedlichen Verlaufe von Cluster 2 und Cluster 3 erklaren kann. Beide Gruppen wiesen zu Beginn der Therapie gleich hohe Depressionswerte auf und unterschieden sich in der weiteren Entwicklung deutlich.

Fragestellung: Zur Haufigkeit einer PTBS nach Stammzelltransplantation (SCT) gibt es in der Literatur unterschiedliche Angaben. Ziel dieser Studie war es, die Auspragung von stressbezogenen Symptomen und die Haufigkeit einer voll ausgebildeten PTBS nach DSM-IV-Kriterien zu erfassen. Methoden: Befragt wurden 110 Patienten (63m/47w, 48,9 Jahre, Zeit nach SCT 32,4 Monate), >6 Monaten nach SCT. Verglichen wurden die Impact of Event Scale (IES- R) und die PTSS–10 mit dem SKID- Interview. Angst und Depressivitat wurden mit der HADS-D erfasst. Ergebnisse: Im IES-R lagen 7,3% der Patienten (n=8), im PTSS10 30,9% (n=34) uber dem Cut off fur eine auf die SCT bezogenen PTBS. Im SKID wurde nur bei 2,7% (n=3) der Patienten eine PTBS diagnostiziert, 15.5% (n=7) litten an einer Anpassungsstorung. Eine voll ausgebildete PTBS-Symptomatik fand sich nur bei Patientinnen, die traumatische Ereignisse im Sinne der A-Kriterien des DSM- IV erlebt hatten. Diskussion: Hohe PTBS-Raten nach Stammzell-Transplantation, die in reinen Fragebogen-Erhebungen gefunden wurden, mussen zuruckhaltend bewertet werden. Problematisch ist v. a. eine valide Erfassung des A2-Kriteriums nach DSM-IV. Die PTSS–10 erfasst mit hoherer Sensitivitat als die HADS die eher unspezifische Symptomatik einer Anpassungsstorung. Zu diskutieren ist, welche klinische Bedeutung die in Fragebogen erfasste Belastung bei Patienten hat, die nicht vollstandig die Kriterien einer PTBS erfullen.

Zur Konfliktbewältigung erwirbt das Kind sozioemotionale Kompetenzen im Rahmen seiner psychischen Entwicklung. Die wachsende Globalisierung macht es erforderlich, den Einfluss so- ziokultureller Systeme unterschiedlicher ethnischer Gruppen auf diese Entwicklung von sozio- emotionalen Kompetenzen von Kindern zu untersuchen. Diese Studie überprüft die Unterschiede von sozioemotionalen Kompetenzen bei Kindern unterschiedlicher ethnischer Gruppen. Zur Erfassung der sozioemotionalen Kompetenzen wurde das Spielverhalten von 84 Kindern (Asia- Amerikaner, Latein-Amerikaner und Afro-Amerikaner) im Alter von vier Jahren zu Beginn des Kindergarten-Jahres mit der Mac Arthur Story Stem Battery (MSSB) untersucht. Ferner wurden zur Erfassung der Bindungsrepräsentationen drei Szenen mit dem Attachment-Doll-Play-Manual ausgewertet. Im Bereich sozioemotionaler Kompetenz konnten signifikante Unterschiede zwi- schen den ethnischen Gruppen bezüglich Problemvermeidung, empathischen und moralischen Themen gefunden werden. Darüber hinaus konnten signifikante Unterschiede zwischen den eth- nischen Gruppen in den Bindungsdimensionen kognitive Starre/Blockieren, bindungsspezifische Verstrickung und Kontrollverhalten identifiziert werden. Möglicherweise sind die ethnisch-spezi- fischen Orientierungen in Erziehung und Sozialisation zum Verständnis für das Konfliktverhal- ten, die Konfliktbewältigung und die Bindungsrepräsentationen heranzuziehen. Schlagwörter Aggression - Ethnizität - Sozialkompetenzen, In its psychological development, the child learns social-emotional competences in order to be able to cope with conflicts. Since ethnic diversity increases due to globalization, the in- fluence of the ethnic background on the social competence children development must be investigated furthermore. The present study examines the differences of the social-emotional competences of children of various ethnic groups. To track the social-emotional competence in play, 84 Asian-American, Latin-American and African-American kindergarteners (age = 4) were tested with the Mac Arthur Story Stem Battery and the attachment representation us- ing the Attachment Doll Play manual. There were significant differences in the avoidance of conflict, empathic and moral themes in problem-solving among the ethnic groups. Further- more, according to ethnic background the children significantly differed in the dimensions of attachment representation, freezing/blocking, constriction and controlling. Since ethnically specific social competence, attachment dimensions and their inter-correlation were found, the children started Kindergarten with differing qualifications. There are indications that the differences in attachment accentuations in children call for ethnic differences in social com- petence and interpretations of social situations in adults and children. Keywords aggression - ethnicity - social competence

Die Soziale Phobie kann nach Willutzki (2005) als intrapersonell formuliertes interpersonelles Problem aufgefasst werden, wobei die Storung mit dem gesamten Spektrum interpersoneller Probleme verbunden ist. In einer naturalistischen Studie an 103 Fallen einer psychosomatischen Universitatsklinik wurde untersucht, ob sich Sozialphobiker (SP, n=60) und Agoraphobiker (AP, n=43) (a) im Muster interpersoneller Probleme unterscheiden u. (b) wie sich diese Muster im Therapieverlauf verandern. Die Diagnosestellung erfolgte standardisiert mittels DIA-X. Erfasst wurden interpersonale Probleme (IIP) u. allgemeine Storungsmase (BDI, KOPS, SCL–90R). Die Ergebnisse zeigen, dass zu Therapiebeginn deutliche storungsspezifische Unterschiede im Muster interpersoneller Probleme bestehen. Patienten mit SP weisen signifikant hohere Werte auf den Skalen zu streitsuchtig, zu abweisend, zu introvertiert, zu selbstunsicher und zu ausnutzbar auf als jene mit AP. Im Therapieverlauf zeigt sich bei SP eine deutliche Reduktion der interpersonalen Probleme in den Bereichen zu abweisend, zu introvertiert, zu selbstunsicher u. zu ausnutzbar, welche als funktional einzuschatzen ist. Im Gegensatz dazu bleibt das Muster interpersonaler Probleme bei AP weitgehend stabil mit signifikant geringeren Werten in den Skalen zu aufdringlich u. zu introvertiert. Die Zusammenhange zur Problembelastung sind masig bis hoch. Die Stabilitat dieser Befunde wird vor dem Hintergrund erster katamnestischer Ergebnisse diskutiert.

Depressive Storungen sind in der psychosomatischen Akutversorgung eine haufige Erkrankung. 67% der untersuchten Patienten (N=194) litten an einer klinisch relevanten Auspragung der Depressivitat. Auf der Basis der Depressionswerte bei Aufnahme, Entlassung, ein Jahr nach Entlassung und der Differenzwerte von Aufnahme-Entlassung und Entlassung-Katamnese wurden clusteranalytisch funf Verlaufstypen identifiziert: Cluster 1 (n=80, 41.2%) masig ausgepragte, kontinuierlich abnehmende Depressivitat, Cluster 2 (n=41, 21.1%) hohe Depressivitat und kontinuierliche, stabile Verbesserung, Cluster 3 (n=32, 16.5%) hohe, stabile Depressivitat, Cluster 4 (n=28, 14.4%) masige Depressivitat und instabile Verbesserung, Cluster 5 (n=13, 6.7%) starke Schwankungen in der Depressivitat. Die Therapieergebnisse blieben im Katamnesezeitraum nicht in allen Gruppen stabil. Ein groser Teil der Patienten (Cluster 1 und Cluster 3, n=121) konnte das erzielte Therapieergebnis halten, in zwei Gruppen (Cluster 4 und Cluster 5, n=41) kam es allerdings im Vergleich zum Therapiebeginn zu einem deutlichen Anstieg der Depressivitat. Ursachen dafur sind moglicherweise negative Therapieeffekte (Cluster 5) und Ruckfalle und soziale Probleme im Katamnesezeitraum (Cluster 4). Offen bleibt, was die unterschiedlichen Verlaufe von Cluster 2 und Cluster 3 erklart. Beide Gruppen wiesen zu Beginn der Therapie gleich hohe Depressionswerte auf und unterschieden sich in der weiteren Entwicklung deutlich.

FRAGESTELLUNG: Im klinischen Setting werden Anpassungsstorungen sehr haufig als Diagnose vergeben, obwohl die diagnostischen Kriterien wenig reliabel und valide sind. Dies hat bisher zu einer Vernachlassigung des Themas in der Forschung gefuhrt. Ein neues Konzept von Maercker et al. (2007) zur Diagnostik von Anpassungsstorungen soll mit diesem Artikel vorgestellt und angewendet werden. METHODE: 96 Patienten einer psychosomatischen Poliklinik wurden hinsichtlich ihrer emotionalen Befindlichkeiten mittels eines neuen Fragebogens (Adjustment Disorder - New Module | ADNM) untersucht. Zudem kam ein strukturiertes Interview zur Erhebung der Anpassungsstorung nach dem neuen Konzept zum Einsatz. In der vorliegenden Studie wurden sowohl das Bewaltigungsverhalten (CISS) als auch die allgemeine Selbstwirksamkeitserwartung (SWE) bei Patienten untersucht, die im ADNM auffallig bzw. unauffallig waren. Folgende statistische Verfahren wurden verwendet: Clusteranalyse, Kreuztabellen, nichtmetrische und metrische Testverfahren. ERGEBNISSE: Die theoriegeleitete Auswertung des Fragebogens ADNM unterteilte die Gesamtstichprobe in ADNM auffallige (49 %) und unauffallige Patienten (51 %). Eine Clusteranalyse der im ADNM auffalligen Patienten zeigte zwei Gruppen, sodass insgesamt drei Gruppen miteinander verglichen werden konnten: im ADNM unauffallige Patienten, im ADNM auffallige Patienten mit geringer Symptombelastung, im ADNM auffallige Patienten mit hoher Symptombelastung. Im ADNM auffallige Patienten zeigten signifikant mehr emotionsorientierte Bewaltigungsstrategien (t = − 6,338; p = 0,000) und gaben an, bezogen auf die vorliegenden Belastungen, sich weniger fahig zu fuhlen, diese zu bewaltigen (Z = − 4,445; p = 0,000). Patienten mit einer hohen Symptombelastung benannten mehr Belastungen (Z = −2,634; p = 0,008) und gaben an, impulsiver und gereizter zu sein (Z = -3,406; p = 0,003). Die Gegenuberstellung des Fragebogens ADNM und der klinischen Hauptdiagnosen zeigte eine Trennung zwischen emotionalen und nicht emotionalen Storungen nach ICD-10 (χ2(2,n = 96) = 6,928; p = 0,031). DISKUSSION: Die Ergebnisse zeigen, dass der Fragebogen ADNM nach dem neuen diagnostischen Konzept der Anpassungsstorung (Maercker et al., 2007) Patienten identifiziert, die durch ausere Lebensumstande stark belastet sind. Das ADNM grenzt zuverlassig die nicht emotionalen von den emotionalen ICD-10-Diagnosen ab. In zukunftigen Studien muss uberpruft werden, ob das neue Konzept sowie der Fragebogen Anpassungsstorungen valide und reliabel erhebt. ------ OBJECTIVE: Diagnoses of adjustment disorders are frequent in clinical settings, although diagnostic criteria are not very reliable or valid. This has led to a neglection of this topic in research. This article presents and applies a new concept (Maercker et al., 2007) for diagnosing adjustment disorders. METHODS: 96 patients of a psychosomatic policlinic were examined regarding their emotional well-being with a new questionnaire (Adjustment Disorder--New Module | ADNM). Furthermore, according to the new concept, adjustment disorders were assessed with a structured interview. Coping behaviour (CISS) as well as general self efficacy (SWE) in patients with scores within a normal range and patients with elevated scores in ADNM, respectively, were examined. The following statistical measures were used: cluster analysis, cross tables, non-metrical and metrical test procedures. RESULTS: The theory-guided evaluation of the ADNM questionnaire divided the whole sample into patients with elevated (49 %) and with normal (51 %) scores. A cluster analysis of patients with elevated scores showed two groups, so that a total of three groups were compared: patients with scores in a normal range; patients with elevated scores and a low number of symptoms; patients with elevated scores and a high number of symptoms. Patients with elevated scores showed significantly more emotion-oriented coping strategies (t = - 6.338; p = 0.000) and reported, referring to present stress, on being less able to cope with it (Z = - 4.445; p = 0.000). Patients with elevated scores and a high number of symptoms named more stress factors (Z = - 2.634; p = 0.008) and reported on being more impulsive and irritable (Z = - 3.406; p = 0.003). The comparison of the ADNM questionnaire and the clinical main diagnoses shows a separation between emotional and non-emotional disturbances according to ICD-10 (chi2(2, n = 96) = 6.928; p = 0.031). DISCUSSION: The results show that the ADNM questionnaire according to the new diagnostic concept of adjustment disorders (Maercker et al., 2007) identifies patients who experience a high degree of stress caused by adverse life events of life conditions. The ADNM reliably differentiates non-emotional from emotional ICD-10 diagnoses. Further studies should examine, whether the new concept as well as the questionnaire are able to assess adjustment disorders in a valid and reliable way.

Diagnoses of adjustment disorders are frequent in clinical settings, although diagnostic criteria are not very reliable or valid. This has led to a neglection of this topic in research. This article presents and applies a new concept (Maercker et al., 2007) for diagnosing adjustment disorders.96 patients of a psychosomatic policlinic were examined regarding their emotional well-being with a new questionnaire (Adjustment Disorder--New Module | ADNM). Furthermore, according to the new concept, adjustment disorders were assessed with a structured interview. Coping behaviour (CISS) as well as general self efficacy (SWE) in patients with scores within a normal range and patients with elevated scores in ADNM, respectively, were examined. The following statistical measures were used: cluster analysis, cross tables, non-metrical and metrical test procedures.The theory-guided evaluation of the ADNM questionnaire divided the whole sample into patients with elevated (49 %) and with normal (51 %) scores. A cluster analysis of patients with elevated scores showed two groups, so that a total of three groups were compared: patients with scores in a normal range; patients with elevated scores and a low number of symptoms; patients with elevated scores and a high number of symptoms. Patients with elevated scores showed significantly more emotion-oriented coping strategies (t = - 6.338; p = 0.000) and reported, referring to present stress, on being less able to cope with it (Z = - 4.445; p = 0.000). Patients with elevated scores and a high number of symptoms named more stress factors (Z = - 2.634; p = 0.008) and reported on being more impulsive and irritable (Z = - 3.406; p = 0.003). The comparison of the ADNM questionnaire and the clinical main diagnoses shows a separation between emotional and non-emotional disturbances according to ICD-10 (chi2(2, n = 96) = 6.928; p = 0.031).The results show that the ADNM questionnaire according to the new diagnostic concept of adjustment disorders (Maercker et al., 2007) identifies patients who experience a high degree of stress caused by adverse life events of life conditions. The ADNM reliably differentiates non-emotional from emotional ICD-10 diagnoses. Further studies should examine, whether the new concept as well as the questionnaire are able to assess adjustment disorders in a valid and reliable way.

Background The majority of studies on taste and smell in eating disorders have revealed several alterations of olfactory or gustatory functions. Aim of this prospective study was to employ detailed olfactory and gustatory testing in female subjects of three homogenous groups – anorexia nervosa, bulimia nervosa and healthy controls – and to look at the effects of treatment on these measures. Methods Sixteen hospitalized female patients with anorexia (restricting type, mean age [M] = 24.5 years), 24 female patients with bulimia (purging type, M = 24.3 years) as well as 23 healthy controls (M = 24.5 years) received olfactory (“Sniffin’ Sticks”) and gustatory testing (“Taste Strips”). Group differences in olfactory and gustatory sensitivity, body mass index (BMI), the Beck depression inventory, the eating attitudes test (EAT), and the influence of therapy on gustatory and olfactory function were investigated. Results (1) Group differences were present for odor discrimination and overall olfactory function with anorexic patients having the lowest scores. (2) Regarding taste function, controls scored higher than patients with anorexia. (3) At admission small but significant correlations were found between overall olfactory function and body weight (r63 = 0.35), BMI (r63 = 0.37), and EAT score (r63 = −0.27). Similarly, (4) the taste test score correlated significantly with body weight (r63 = 0.48), and BMI (r63 = 0.45). Finally, (5) at discharge overall olfactory and gustatory function were significantly higher compared to admission in anorexic patients. Conclusions As compared to healthy controls and bulimic patients our results show lowered olfactory and gustatory sensitivities in anorexic patients that improved with increasing BMI and decreasing eating pathology in the course of treatment.

Partners or spouses of patients with cardiac arrhythmias were examined for mental and physical health. In addition, gender differences and other influential factors of well-being were analyzed.A total of 486 partners or spouses took part in a study which collected data on anxiety and depression (HADS-D) as well as quality of life (SF-12). The situation of the partners was correlated with social variables, psychological distress, and the physical and mental well-being of the patients.Pathological anxiety was reported by 20 percent of the partners and 37 percent demonstrated notable values for depression. In comparison to healthy samples quality of life was diminished, especially in male subjects. There was a strong inter-connection between the patient's psychological strain and that of his or her partner. Most important for the partner's physical quality of life was the patient's quality of life (18.4% explained variance). The partner's mental well-being was determined by his or her own psychological distress (31.1% explained variance).Spouses and partners of patients with cardiac arrhythmias are highly impaired in their psychological well-being. This should be taken into account when dealing with medical care issues in such patients. It is therefore important to inform patients and their families in detail about the potential risks as well as the options for relatives' responses in arrhythmia-induced emergencies.

The influence of psychotherapeutic interventions on the long-term course of anxiety and depression of inpatients of a Gynaecological University Hospital was examined in a prospective naturalistic provision study. All patients admitted to hospital within a year were examined regarding anxiety and depression (HADS). The patients who had conspicuous values in their questionnaires were randomly assigned to an intervention or a control group. There was a follow-up examination for them one year after the first examination. In the first examination 715 participants took part, in the follow-up examination there were 429. Women with malignant gynaecological diseases suffer more severely from anxiety (t=7.02; p0.001) and depression (t=3.87; p0.001) in comparison with the normal population. Women suffering from general gynaecological (t=7.75; p0.001) and obstetrical diseases (t=5.95; p0.001) are significantly more anxious. Whereas the anxiety in patients with general gynaecological (F=3.02; p=0.031) as well as in patients with obstetrical diseases (F=3.52; p=0.017) can be reduced significantly in the long-term by psychotherapeutic interventions, depression cannot or only slightly be influenced. This shows that low-frequent psychotherapeutic interventions with psycho-educative, supportive approaches (e. g. in the framework of psychosomatic consultation and liaison service) have positive effects on anxiety in the long run, whereas depression is to be influenced rather by long-term interventions or classic depth-psychological or behaviour therapeutic interventions.

Psychosomatische Faktoren, u.a. auch die Stressreagibilitat, wurden bei Weiskittelhypertonikern (10–30% der Normalbevolkerung) bisher kaum untersucht. Die Probanden wurden Stress- (Arztimagination; Anagrammaufgabe; Sozialer Stresstest) und Entspannungssituationen ausgesetzt. Die Herzratenvariabilitat wird uber das Verhaltnis von Low und High Frequenzy (LF/HF) sowie die RMSSD operationalisiert. Es wurden 10 Weiskittelhypertonikern (49,0±15,3 Jahre; 70% Frauen), 15 Normotonikern (38,8±14,6 Jahre; 70% Frauen) sowie 15 Hypertonikern (56,1±13,3 Jahre; 40% Frauen) verglichen. Bei Kontrolle des Alters zeigt sich ein signifikanter Effekt in der Reaktion auf Sozialen Stress (p=0,012). Weiskittelhypertoniker (MLF/HF=10,0±6,2) weisen eine verstarkte Sympatikusreaktion im Vergleich zu Normotonikern (MLF/HF=5,4±3,3) und Hypertonikern (MLF/HF=4,9±3,6) auf. Weiskittelhypertoniker zeigen in allen Stresssituationen tendenziell hohere LF/HF-Verhaltnisse (p=0,059) und eingeschrankte RMSSD-Werte (p=0,068) sowie in allen Entspannungssituationen eingeschrankte RMSSD-Werte (p=0,068). Es findet sich bei Weiskittelhypertonikern eine vermehrte Stressreagibilitat, vor allem in sozialen Situationen, was einen Ansatzpunkt fur therapeutische Interventionen darstellen konnte.