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Anorexia nervosa is a serious illness leading to substantial morbidity and mortality. The Anorexia Nervosa Treatment of Outpatients (ANTOP) study is the largest randomised controlled trial (RCT) globally that uses psychotherapy in outpatients with anorexia nervosa. In this Article, we report the results of the 5-year follow-up.The ANTOP study is an open-label, multicentre RCT involving 242 adult female outpatients with anorexia nervosa. Participants were recruited from ten university hospitals in Germany, had to be aged at least 18 years and female, and have a diagnosis of anorexia nervosa with a body-mass index (BMI) of 15·0-18·5 kg/mBetween May, 2007, and June, 2009, we screened 727 patients for eligibility; at baseline, 242 patients with a mean BMI of 16·7 kg/mThe long-term results of the ANTOP trial confirm the improvement in BMI of patients with anorexia nervosa in all groups; however, a substantial proportion of patients had a poor global outcome. The predictors for the long-term course of anorexia nervosa in our ANTOP study show that we need to treat patients with anorexia nervosa at an earlier stage of the disease, with a clear focus on weight gain and considering other comorbidities (especially depression).German Federal Ministry of Education and Research.

Improvement in patients' mentalizing capacities is considered a possible mechanism of change in psychotherapy. This improvement might take place via mentalization-enhancing interventions (MEIs) performed by psychotherapists. The study aimed to explore the use of MEIs in two evidence-based psychotherapeutic treatments for patients with anorexia nervosa (enhanced cognitive-behavior therapy, focal psychodynamic therapy) and their association with the patients' capacity to mentalize in sessions ("in-session reflective functioning" / in-session RF). Additionally, it was explored, if the amount of MEIs used could either predict change in in-session RF or outcome (end of treatment, one year follow-up).84 audiotapes from psychotherapy sessions of 28 patients of the ANTOP-study (three sessions per patient) were transcribed and rated with both the MEI Rating Scale and the In-Session RF Scale by trained raters.MEIs were applied in both treatments. A moderate correlation between the amount of MEIs and patients' in-session RF as well as its change over the course of treatment was found, but no relation to change in BMI or eating disorder symptoms.A greater use of MEIs was related to patients' in-session-mentalizing. However, there seems to be no simple relation between RF as shown in sessions and symptom change.

ObjectivePrevious research suggests that patients with anorexia nervosa (AN) show an impaired capacity to mentalize (reflective functioning, RF). RF is discussed as a possible predictor of outcome in psychotherapeutic processes. The study aimed to explore RF in sessions of patients with AN and its association with outcome and type of treatment.MethodsA post-hoc data analysis of selected cases from a randomized trial on outpatient psychotherapy for AN was conducted. Transcripts from 84 sessions of 28 patients (early phase, middle phase, and end of treatment) were assessed using the In-Session-Reflective-Functioning-Scale [14 cognitive-behavior therapy, enhanced (CBT-E); 14 focal psychodynamic therapy (FPT); 16 with good, 12 with poor outcome after 1 year]. Relations between the level of RF, type of treatment, and outcome were investigated using mixed linear models. Additionally, associations with depressive symptoms, weight gain, and therapeutic alliance were explored.ResultsMean in-session RF was low. It was higher in FPT when compared to CBT-E treatments. The findings point to an association between RF increase and a positive outcome. An increase in BMI in the first half of treatment was associated with higher subsequent in-session RF. There was no association between RF and depressive symptoms or the therapeutic alliance.DiscussionPatients with AN show a low capacity to mentalize in sessions, which seems to be at least partly dependent on the degree of starvation. The results suggest a possible relationship between an increase in in-session RF and outcome, which has to be replicated by further studies.

Introduction: In January 2016, 2057 refugees from civil war-torn Syria and Iraq, aged 18.0 to 24.9 years, were first-time entrants into the German unemployment register and thus potentially eligible for the labor market. Civil war and forced migration may affect individuals' mental health. Traumatic experiences in particular are assumed to represent a major barrier, e.g., to labor-market integration. This study aimed to screen the rates of posttraumatic stress disorder (PTSD). Former refugee studies have reported PTSD screening rates between 3% and 44%. Method: A total of 8.5% (N = 175 of 2057) of respondents were randomly interviewed either by telephone or web-based interviews. A total of 84 respondents (48% out of 175 respondents) were screened using the Essen Trauma Inventory (ETI) based on the DSM-IV, and 91 (52%) respondents used the Short Screening Scale for Posttraumatic Stress Disorder (SSS-PSD). All respondents were additionally questioned regarding psychological impairment (Symptom Checklist 10) and health status (Short Form 12). Results: Of the respondents, 59.4% reported at least one traumatic experience. The percentage of positive PTSD screenings obtained using the ETI was 9.5% (N = 84) and 6.6% (N = 91) using the SSS-PSD. The percentage of positive PTSD screenings obtained with both screening instruments was 8% (N = 175; 95%-CI: 3.9% to 12.1%). A total of 19.4% of the subjects were above the SCL-10 cut-off for psychiatric caseness. Discussion: The PTSD rate in this sample was in the average range compared to previous estimates from large samples of refugees. Psychiatric caseness was high. The results should be considered for planning labor-market integration programs and the design of supportive schemes. Keywords: Posttraumatic Stress Disorder, PTSD, Psychopathology, Refugee, Unemployment

Introduction Frailty has been discussed as a predictor of morbidity and mortality for liver cirrhosis. The aim of our study is to evaluate the role of frailty in liver transplantation, particularly for patients with MELD scores < 15. Methods All patients listed for liver transplantation between September 2015 and November 2018 were prospectively included in the study. Frailty was assessed by Fried’s frailty classification. Pre-, intra-, and postoperative data were prospectively recorded. Univariate and multivariate regression analyses were performed. The ethical approval of the institutional board review was obtained for the study. Results There were 114 patients included in the study, and their median MELD score was 16. Of these, 86 patients were defined as frail (75.4%). A total of 62 patients (54.4%) underwent liver transplantation, 11 (17.7%) died postoperatively, and 24 patients (21.0%) died while on the waitlist. All postoperative mortality cases were frail, and only 3 patients (12.5%) were non-frail in the waitlist mortality group. There were 14 patients who had MELD scores of <15 (58.3%). The overall survival of non-frail patients was significantly better than that of frail patients. The multivariate regression analyses identified frailty criteria, including unintended weight loss and low hand grip strength, and platelet count and being married or living in a solid partnership were prognostic factors for survival in all patients. Conclusion The addition of frailty assessment can be beneficial for predicting mortality after liver transplantation, especially in patients with low MELD score. Frail patients on the waitlist have significant risk for mortality even with low MELD score.

INTRODUCTION AND OBJECTIVE:Male to female (MtF) gender affirming surgery (GAS) comprises the resection of the testes and the erectile tissue and formation of a functional and aesthetic vaginal cavi...

Additional file 1. Correlation matrix.

This study investigates the role of body image self-appraisal in predicting the outcomes of outpatient psychotherapy in patients with anorexia nervosa (AN). Multiple linear regression analyses and a path-analysis model were applied to test the study hypotheses that body image at baseline predicts treatment outcomes of outpatient psychotherapy in patients with AN at follow-up measurement. The analyses were conducted as secondary analyses in a subgroup (n = 148) of the anorexia nervosa treatment of outpatient-cohort (ANTOP-study) (N = 242) of patients with AN. The results show that Negative Evaluation of the Body at baseline predicts perceived stress during psychotherapy, which in turn predicts depressive symptoms at the end of therapy which in turn predicts the outcomes body mass index and EDI-2 sum score at 12 months follow-up. The results underline the importance of body image disturbance in the course of AN and call for body image as a central target of psychotherapeutic interventions in patients with AN.

Introduction Psychosocial resources like social support or intrapersonal coping skills play an important role in resilience and quality of life (QOL), yet research systematically investigating the availability of different resources and QOL in transgender (trans) women is missing. Aim The present study aimed to systematically investigate the existence of different psychosocial resources and QOL in trans women following gender-affirming surgery (GAS). Methods Using a cross-sectional design, 557 trans women who had received GAS at the local urological department were invited to study participation. Criteria for study inclusion were 18 years and older, diagnosis of transsexualism according to the International Classification of Disease, completion of all sessions of GAS, and given written informed consent to study participation. Main Outcome Measures Psychosocial resources were assessed using the Essen Resource Inventory (ERI), the Sense of Coherence Scale, and the Social Support Scale. QOL was assessed with the Short Form Health Survey. Data from trans women were compared to normative data of healthy non-trans women as reported in the respective test manuals. Results In total, 158 trans women responded and participated in this study. They had received GAS 4 months to 21 years ago. The total sample was divided into 3 subgroups depending on the time interval since the participants’ last GAS procedure (group 1: GAS 0.3−3 years ago (n = 48); group 2: GAS 3.1−10 years ago (n = 62); and group 3: GAS 10.1−21 years ago (n = 41)). Trans women retrospectively indicated their available resources 3 years ago (ERI 3-years) and in the last 4 weeks (ERI 4-weeks). Trans women who had received GAS within the last 3 years (group 1) showed an increase in resources when comparing ERI 3-year scores (presurgery) with ERI 4-week scores (postsurgery). No differences emerged for group 2 and group 3. Compared to normative data from non-trans women, trans women scored significantly lower on the ERI but not in measures of Social Support Scale or Sense of Coherence Scale. Compared to non-trans women, mental QOL was significantly impaired in trans women, whereas no differences in physical QOL emerged. Clinical Implications As this study hints towards reduced psychosocial resources in trans women, the offering of specialized counseling can have high beneficial potential to support the development of resources, thereby enhancing QOL. Strength & Limitations Data of a large sample of trans women is provided who were investigated up to 21 years after GAS. The study is limited by its cross-sectional design and the response rate of 42%. Conclusion This study indicates that psychosocial resources improve around the time of GAS and seem to be improved and sustained in later years following GAS. Still, compared to non-trans women, trans women have a lower availability of resources and a lower mental QOL.

ZusammenfassungDie Kunsttherapie ist eine klinisch anerkannte Therapiemethode, jedoch gibt es immer noch sehr wenige Studien, die sich mit der Wirksamkeit, Wirkfaktoren oder Wirkweisen der Kunsttherapie auseinandersetzen. Insbesondere fehlt bis zum heutigen Zeitpunkt ein speziell für die Kunsttherapie zugeschnittenes und psychometrisch überprüftes Forschungsinstrument, welches Erlebensdimensionen der Kunsttherapiegruppe aus Patientensicht misst. Ein solches Messinstrument könnte Hinweise auf deren Wirksamkeit geben, kunsttherapeutische Gruppenprozesse besser verstehen lassen und zur Qualitätssicherung dienen. Ziel der vorliegenden Untersuchung war die Entwicklung und Validierung des Fragebogens zum Erleben der Kunsttherapiegruppe aus Patientensicht (FEKTP). Dieser Fragebogen basiert auf Grawes und Yaloms Konzepten zu gruppentherapeutischen Wirkfaktoren. Es nahmen 133 Patienten an der Studie teil und beantworteten den FEKTP direkt nach der 6. Kunsttherapiesitzung. Die Patienten bearbeiteten zusätzlich etablierte Symptom- und Erfahrungsfragebögen zu Beginn und zum Ende der Behandlung. Die Faktorenanalysen ergaben eine eindeutige Faktorenstruktur des FEKTP, welche die theoretisch angenommenen Subskalen zum Großteil einordnet. Die testpsychometrischen Hauptgütekriterien des FEKTP (Reliabilität, Validität und Objektivität) lassen sich als gut bis akzeptabel einordnen. Die Kriteriumsvalidität sollte aber in zukünftigen Studien nochmals genauer überprüft werden. Somit liegt nun auch für die Kunsttherapie ein valides Instrument zur systemischen Erfassung von allgemeinen Wirkfaktoren vor. Die Anwendung empfiehlt sich im Forschungs- als auch im Versorgungskontext.

Objectives: The purpose of this study is to examine the use of assistive technology, social support in everyday life and psychological existential orientation for individuals with physical disabilities. Methods: Forty-six elderly persons with physical disabilities (aged 73.7±10.6 years, range 53-93 years) were examined with regard to the use of assistive technology, social support in everyday life and psychological existential orientation by an extensive questionnaire set (questionnaire for assistive technology (AT-24), questionnaire for social support (F-SOZU-K-22) and Brief Symptom Inventory (BSI)). Results: The subjects stated that they needed aid and social support in order to carry out their daily indoor/outdoor activities (for e.g. dressing, having a bath / shower, using toilet, eating, going up / down the stairs, shopping, or going out). The most commonly used mobility aid was the walking frame that accounted for 61.9%, followed by the walking stick with 40.5% and a bathtub lift with 21.4%. The results also showed the psychopathological symptoms in the sample. Discussion: Assistive technologies together with the support of relatives and care services help people to cope with a variety of activities in their daily lives with fewer restrictions. The effectiveness of the aids differs between participants because it depends on several factors such as health, knowledge, and information about aids, as well as the appropriate selection of aids.

Objective The “inter session process” (ISP) is defined as therapy-related conscious thoughts, memories, and emotions that patients and therapists experience between psychotherapy sessions. It indicates how the participants process and use treatment. The main aim of this study is to describe the ISP characteristics of patients in outpatient treatment for anorexia nervosa (AN). An additional aim is to explore the relation between patients' ISP and treatment outcome. Method Patients taking part in a randomized controlled trial on outpatient psychotherapy for AN (ANTOP) filled in the Intersession Experience Questionnaire before each of the 40 psychotherapy sessions. Trajectories of different aspects of the ISP were analyzed with growth curve models based on orthogonal polynomials and tested for differences between 3 outcome categories (recovery, partially recovered, full syndrome AN). Results Data from 108 cases were available for analysis. ISP facets showed diverse, mostly nonlinear, trajectories over the course of treatment. Less favorable outcomes were associated with higher levels of patients’ experiencing negative emotions when recalling therapeutic dialogue, thinking about therapy during dreaming/drowsy states, and applying therapeutic learning (in the second half of treatment). Conclusions Findings confirm an overall relation between ISP and treatment outcome. In outpatient treatment in AN, patients with a less successful course seem to be more preoccupied with therapy and therapist between sessions. For the ISP facet “applying therapeutic learning,” findings point to an optimal range dependent on treatment phase. Growth curve modeling is required to describe the nonlinear trajectories of ISP facets.

Art therapy is a clinically accepted method of therapy, but there are still very few studies that deal with the efficacy, change factors or mode of action of art therapy. In particular, there is a dearth of research instruments and psychometrically verified research tools specially fitted for art therapy which measures the experience dimensions of the art therapy group from the patient's point of view. Hence, it provides evidence of its effectiveness, better understands the art therapy group processes and serves quality assurance. The aim of the present study was to develop and validate the questionnaire on the experience of the art therapy group from patient view (FEKTP). This questionnaire is based on Grawe's and Yalom's conceptions of change factors in group therapy. 133 patients participated in the study and completed the FEKTP directly after the 6th art therapy session. Patients additionally received established questionnaires concerning clinical symptoms and experience processes at the beginning and end of treatment. Factor analysis demonstrated a clear factor structure of the FEKTP, which corresponded to the theoretically predicted subscales to the greatest extent. The test psychometric main quality criteria of the FEKTP (reliability, validity and objectivity) can be classified as acceptable to good range. The criterion validity appear to be given, but should be examined more exactly in future studies. Thus, a valid instrument for the systemic detection of general change factors for art therapy is now available. The questionnaire can be recommended for research as well as clinical contexts.Die Kunsttherapie ist eine klinisch anerkannte Therapiemethode, jedoch gibt es immer noch sehr wenige Studien, die sich mit der Wirksamkeit, Wirkfaktoren oder Wirkweisen der Kunsttherapie auseinandersetzen. Insbesondere fehlt bis zum heutigen Zeitpunkt ein speziell für die Kunsttherapie zugeschnittenes und psychometrisch überprüftes Forschungsinstrument, welches Erlebensdimensionen der Kunsttherapiegruppe aus Patientensicht misst. Ein solches Messinstrument könnte Hinweise auf deren Wirksamkeit geben, kunsttherapeutische Gruppenprozesse besser verstehen lassen und zur Qualitätssicherung dienen. Ziel der vorliegenden Untersuchung war die Entwicklung und Validierung des Fragebogens zum Erleben der Kunsttherapiegruppe aus Patientensicht (FEKTP). Dieser Fragebogen basiert auf Grawes und Yaloms Konzepten zu gruppentherapeutischen Wirkfaktoren. Es nahmen 133 Patienten an der Studie teil und beantworteten den FEKTP direkt nach der 6. Kunsttherapiesitzung. Die Patienten bearbeiteten zusätzlich etablierte Symptom- und Erfahrungsfragebögen zu Beginn und zum Ende der Behandlung. Die Faktorenanalysen ergaben eine eindeutige Faktorenstruktur des FEKTP, welche die theoretisch angenommenen Subskalen zum Großteil einordnet. Die testpsychometrischen Hauptgütekriterien des FEKTP (Reliabilität, Validität und Objektivität) lassen sich als gut bis akzeptabel einordnen. Die Kriteriumsvalidität sollte aber in zukünftigen Studien nochmals genauer überprüft werden. Somit liegt nun auch für die Kunsttherapie ein valides Instrument zur systemischen Erfassung von allgemeinen Wirkfaktoren vor. Die Anwendung empfiehlt sich im Forschungs- als auch im Versorgungskontext.

Zusammenfassung Einleitung: Die spezifische Lebensqualität (LQ) transidenter Menschen ist bislang unzureichend untersucht worden, zudem existiert bislang kein Messverfahren zur Erfassung der transidentitätsspezifischen LQ. Forschungsziele: Ziel der Studie war es, das Essener Transidentität Lebensqualitäts-Inventar (ETLI), bestehend aus 30 Items, zu entwickeln und zu validieren. Methoden: Bei 158 Mann-zu-Frau (MzF) transidenten Personen wurden neben dem ETLI Instrumente zur Erfassung von LQ, sozialer Unterstützung, individueller Ressourcen und psychischer Belastung eingesetzt. Es wurde eine explorative Faktorenanalyse durchgeführt. Ergebnisse: Mittels der explorativen Faktorenanalyse wurden die vier Dimensionen psychische, körperliche und soziale LQ sowie LQ durch Offenheit identifiziert. Die Subskalen zeigten eine gute Reliabilität mit Werten von Cronbachs α zwischen α = .75 und α = .89, die Gesamtreliabilität betrug α = .89. Positive Korrelationen des ETLI mit generischer LQ und Ressourcen sowie negative Korrelationen mit psychischer Belastung weisen auf eine sehr gute Konstruktvalidität hin. Schlussfolgerung: Das ETLI als Instrument zur Erfassung der transidentitätsspezifischen LQ stellt eine wichtige Ergänzung zu Messinstrumenten der generischen LQ dar. Es kann im Forschungs- und Versorgungskontext sowie bei der retrospektiven Evaluation von Veränderungen der LQ und bei der Therapieplanung zum Einsatz kommen.

Background: As findings regarding predictors for good outcome after total joint arthroplasty are highly inconsistent, aim of this study was to investigate the influence of the psychosocial variables sense of coherence and social support as well as mental distress on physical outcome after surgery. It should be investigated if different predictors are important in patients after total hip arthroplasty (THA) compared to patients after total knee arthroplasty (TKA). Methods: In a prospective design, 44 patients undergoing THA and 61 patients undergoing TKA were examined presurgery and 6 and 12 weeks after surgery using WOMAC (disease-specific outcome), SF-36 (health-related quality of life), BSI (psychological distress), SOC-13 (sense of coherence), and F-SozU (social support). Changes over time were calculated by analyses of variance with repeated measures. Stepwise multiple linear regression analyses were computed for each group to predict scores of WOMAC total and all WOMAC subscales 12 weeks postoperatively. Results: THA as well as TKA patients experienced improvements in all parameters (effect sizes for WOMAC scores between η² =.387 and η² =.631) with THA patients showing even better results than TKA patients. WOMAC scores 12 weeks after surgery were predicted predominantly by WOMAC baseline scores in TKA with an amount of explained variance between 9.6 and 19.5%. In THA, 12-weeks WOMAC scores were predicted by baseline measures of psychosocial aspects (anxiety, sense of coherence, social support). In this group, predictors accounted for 17.1 to 31.6% of the variance. Conclusions: Different predictors for outcome after total joint arthroplasty were obtained for THA and TKA patients. Although psychosocial aspects seemed to be less important in TKA patients, preoperatively, distressed patients of both groups should be offered interventions to reduce psychological distress to obtain better outcomes after surgery. CA Lindner

Der Einfluss von Familie, Partnerschaft, Bildung oder beruflicher Situation auf Entstehung und Aufrechterhaltung der Anorexia nervosa (AN) wurde vielfach diskutiert. Bereits in den ersten Beschreibungen der Erkrankung wurde detailliert Bezug zu Dimensionen des Familiensystems genommen. Dennoch ist die Evidenz zur Auswirkung dieser Variablen auf den Verlauf der Krankheit bis heute unklar. Randomisierte, kontrollierte Studien zu den Effekten von Psychotherapie geben wenige Information, wie diese Variablen bei den teilnehmenden Patientinnen verteilt sind, insbesondere auch, welchen Einfluss sie auf das Outcome der Studien haben. Ziel vorliegender Arbeit war es, die Patientinnen aus der Studie „Anorexia Nervosa Treatment of Outpatients“ (ANTOP) – der weltweit grosten ambulanten Therapiestudie zu AN – hinsichtlich der Einflusse von Familie, Partnerschaft und Berufskontext auf den Behandlungserfolg zu untersuchen. Die Ergebnisse zeigen Hinweise, dass Patientinnen in der ANTOP-Studie einen hoheren Bildungsstand als der altersentsprechende Bevolkerungsdurchschnitt haben. Gleichzeitig scheinen sie weniger haufig in einer institutionalisierten Partnerschaft zu sein. Bezuglich der Berufstatigkeit gibt es keine Unterschiede. Erhobene Variablen zu Familie, Partnerschaft, Bildung und beruflicher Situation hatten keinen pradiktiven Wert bezuglich des gewichtsbezogenen Therapie-Outcome in der ANTOP-Studie.

Die Lebensqualitat von Menschen mit psychischen Storungen ist in der Regel stark reduziert und sollte wahrend der Behandlung mit berucksichtigt werden. Der vorliegende Beitrag bietet eine Ubersicht uber Studien zur Effektivitat von psychotherapeutischen Interventionen zur Verbesserung der Lebensqualitat von Betroffenen mit Essstorungen. Eine umfassende elektronische Literaturrecherche ergab 10 Studien, die den Ein- und Ausschlusskriterien unserer Arbeit entsprachen und integriert wurden, 3 davon waren randomisierte Kontrollstudien. Die Art der Interventionen sowie die Messinstrumente zur Erfassung der Lebensqualitat unterschieden sich stark zwischen den Studien. Insgesamt zeigte sich eine signifikante Verbesserung der Lebensqualitat durch psychotherapeutische Behandlung. Jedoch besteht weiterhin die Frage, welche Faktoren in der Psychotherapie zur Verbesserung der Lebensqualitat beitragen. Die Durchfuhrung weiterer randomisierter Kontrollstudien mit standardisierten methodischen Messverfahren wird empfohlen, auch um den Langzeiteffekt von Psychotherapie auf die Lebensqualitat bei Essstorungen zu untersuchen.

Das Ziel dieser Arbeit war der Vergleich von Psychotherapiepatienten im Kindes- und Jugendalter mit Schülern bezüglich der Prävalenz potentiell traumatischer Ereignisse, der posttraumatischen Symptomatik und der psychischen Belastung. Zudem wurden der Einfluss kumulativer Traumata auf posttraumatisches Erleben und mögliche Prädiktoren einer PTBS untersucht. Mit Hilfe des Essener Trauma-Inventars für Kinder und Jugendliche (ETI-KJ) und der Symptom Check-Liste 27 (SCL-27) wurden 96 Therapiepatienten mit 99 Schülern im Alter von 12 bis 17 verglichen. Hinsichtlich der Prävalenz potentiell traumatischer Ereignisse konnte kein Unterschied zwischen den Gruppen festgestellt werden. Patienten berichteten häufiger von interpersonellen Traumata und waren von einer höheren Anzahl persönlich erlebter Traumata betroffen. Für beide Gruppen erwiesen sich Alter, weibliches Geschlecht, die Anzahl traumatischer Erlebnisse sowie sexueller Missbrauch als signifikante Prädiktoren für die PTBS-Symptomatik. Kumulative und interpersonelle Traumata führen zu schweren psychosozialen Folgen bei Kindern und Jugendlichen. Daher gilt es diese standardmäßig zu eruieren und die Chronifizierung einer PTBS zu vermeiden.

BackgroundAnorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive–behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN.MethodThe analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost–utility and assumptions underlying the base case were investigated in exploratory analyses.ResultsCosts of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained ConclusionsDepending on the WTP, FPT proved cost-effective in the treatment of adult AN.

Emotional Expression Predicts Treatment Outcome in Focal Psychodynamic and Cognitive Behavioural Therapy for Anorexia Nervosa: Findings from the ANTOP Study

Body image disturbance represents a central characteristic of anorexia nervosa (AN). Depression and anxiety are the most common mental comorbidities in patients with AN. This study aims to investigate the relationship of body image with symptoms of depression and anxiety during outpatient psychotherapy in AN. Analyses were conducted using the data set of the Anorexia Nervosa Treatment Outpatient Study (ANTOP) randomized controlled trial. The ANTOP study included N = 242 females with AN between 18 and 56 years of age. The trial was designed to compare enhanced cognitive behavioral therapy (CBT-E) and focal psychodynamic therapy (FPT) with optimized treatment as usual (TAU-O) for patients with AN. The analyses on body image dimensions were conducted using measures of correlations and multiple linear regression analyses to assess the relationship and longitudinal prediction of symptoms of depression and anxiety by body image dimensions. Results showed that body image perceptions were significantly associated with symptoms of depression and anxiety in patients with AN at all treatment stages. In addition, body image dimensions at early treatment stages predict depression and anxiety in follow-up measurements. The correlation of symptoms of depression and anxiety by body image perceptions increased along treatment course. The persistence of body image disturbance, while body mass index increases under treatment (persistency effect), may constitute a relevant factor contributing to the course of the most common affective comorbidities of depression and anxiety in patients with AN. Body image disturbances in patients with AN should therefore be explicitly targeted within the specialized psychotherapy of affected patients. (PsycINFO Database Record

Bei türkischstämmigen Migranten ist die Inanspruchnahme psychotherapeutischer Behandlung häufig mit somatoformen Beschwerden verknüpft. Zur besseren Objektivierung dieser Beschwerden wurde das Screening für Somatoforme Störungen (SOMS), das körperliche Beschwerden nicht organischer Genese erfasst, in die türkische Sprache übersetzt und anhand einer Stichprobe von 114 türkischsprachigen Patienten einer muttersprachlichen psychosomatischen Ambulanz sowie einer Gruppe von 105 psychisch unauffälligen türkischen Migranten validiert. Die türkische Version des SOMS wies eine hohe interne Konsistenz (von α = 0.78 bis α = 0.93), eine hohe konkurrente und divergente Validität (von r = .37 bis r = –.48) anhand von Depressivitätsscores nach dem Beck-Depressions-Inventar und dem Gesamtscore des Kohärenzgefühls nach der Sense of Coherence Scale sowie eine hohe diskriminante Validität auf. Mit der türkischen Version des SOMS wird ein verständliches, reliables und valides Instrument zur Erfassung somatoformer Symptome bei türkischen Migranten vorgelegt.

Eine valide Diagnostik zahlt zu den wesentlichen Grundlagen der erfolgreichen psychotherapeutischen Behandlung. Gerade bei den Traumafolgestorungen ist das nicht immer erfullt, insbesondere dann, wenn Fragebogen zum Einsatz kommen, die die Kriterien einer Traumafolgestorung gemas der Klassifikationssysteme Diagnostic and Statistical Manual of Mental Disorders(DSM)-IV und International Statistical Classification of Diseases and Related Health Problems(ICD)-10 nicht vollstandig berucksichtigen. In der vorliegenden Ubersichtsarbeit werden haufig verwendete Traumafragebogen im deutschen Sprachraum fur Erwachsene sowie fur Kinder und Jugendliche mit ihren Besonderheiten vorgestellt und kritisch diskutiert. Abschliesend werden Empfehlungen fur die Diagnostik von Traumafolgestorungen mithilfe von Fragebogen vorgenommen.

The aim of the present prospective-naturalistic study was the evaluation of psychosomatic inpatient treatment for anorexia nervosa (AN) and bulimia nervosa (BN). 128 patients with eating disorders (n=59 AN and n=69 BN) were investigated on admission and discharge using the following standardized questionnaires: eating disorder symptoms (EDI), general psychopathology (BSI), quality of life (SF-12), and personal resources (SOC-13, SWE). Moderate to large effect sizes were achieved for the eating disorder symptoms; in addition, general psychopathology was substantially reduced at the end of treatment, and quality of life as well as personal resources were enhanced. Personal resources were found to be the strongest predictors for therapy outcome. Based on our data, important insights and recommendations may be gained for the inpatient treatment of eating disorders, especially with regard to the potential influence of personal resources.

Several lines of evidence point to a close relationship between the hormones of energy homeostasis and the olfactory system. Examples are the localization of leptin and adiponectin receptors in the olfactory system or increased activation of brain regions related to the palatability and the hedonic value of food in response to food pictures after application of ghrelin. In this preliminary study, we tested in 31 subjects (17 male and 14 female) if and to what extent the peripheral blood concentrations of "satiety" hormones, such as leptin, adiponectin, and ghrelin (acyl and total), are correlated with the self-ratings of odor pleasantness and with the objective olfactory and gustatory ability. The hedonic values of some odors were found to be differently rated between donors depending on gender and body weight. The concentrations of leptin, adiponectin and total ghrelin were significantly associated with the hedonic value of pepper black oil, but failed to show significant correlations for 5 other odors tested. Except for a significant association between leptin and odor identification, hormone concentrations were not linked to the abilities of smell and taste. Peripheral adipokines and gut hormones may alter the perception and pleasantness of specific odors, presumably either directly through their receptors in the olfactory system or indirectly through central interfaces between the regulation systems of olfaction, appetite control, memory and motivation.

It was analysed if the weight course in the first half of a four-step psychosomatic treatment program for inpatients with Anorexia nervosa (AN) was useful to predict premature termination of treatment. The weight courses, sociodemographic and disorder-related data of 121 female adult inpatients were investigated. 39% of the studied patients did not reach their target weight (not completers). 61% of the patients completed all four steps of treatment (completers). The not completers showed significant more time with weight losses in the first step and had more and bigger weight losses in the second step of treatment than the completers. Furthermore, they had fewer comorbid depression. In contrast to the sociodemografic and disorder-related data, the weight courses in the first treatment half were very useful to predict premature termination of treatment for inpatients with AN.

Anliegen Wir untersuchten den Zusammenhang zwischen dem Ausmas der religiosen Bindung, der allgemeinen psychischen Symptombelastung und unterschiedlichen Aspekten der Integration bei turkischen / kurdischen Migranten in der Primarversorgung. Methode Es wurde ein Vergleich der Migrantengruppe (n = 179, Alter M = 39,4 Jahre, 65,0 % weiblich) mit deutschen dermatologischen Patienten (n = 184, Alter M = 43,1 Jahre, 60,9 % weiblich) bezuglich der Religiositat hergestellt. Ergebnisse Im Durchschnitt lebten die Migranten seit 24,98 Jahren (SD = 8,90) in der BRD. Im Vergleich zur deutschen Vergleichsgruppe schatzten sich die Migranten hochsignifikant religioser ein (p

OBJECTIVE The aim of the current study was to examine the occurrence of sense of coherence (SOC) and the relationship between SOC and anxiety, depression, somatoform complaints and life satisfaction in female bulimia nervosa (BN) outpatients. METHODS In a consecutive cross-sectional study 73 BN outpatients (age 26.9 years, SD 7.8) were assesssed with the Sense of Coherence Scale (SOC-13), the Hospital Anxiety and Depression Scale (HADS-D), and the Screening for Somatoform Disorders (SOMS-2). RESULTS The BN outpatients showed highly reduced SOC in comparison to the reference group (M = 45.09 vs. M = 71.23; p < or = 0.001). SOC significantly correlated inversely with depression and somatoform complaints. Additionally, there was a positive correlation between SOC and life satisfaction (r = 0.467; p < or = 0.001). Interestingly, SOC was not significantly correlated with anxiety. CONCLUSIONS The results support the thesis that female BN outpatients could benefit from an enhancement of SOC particularly with regard to depression and somatoform complaints.

Summary Background Health-related quality of life (HRQOL) is a marker of disease severity. Data on the relative impairment of HRQOL in chronic liver disease (CLD) and functional gastrointestinal disorders are lacking and no studies have assessed the link between impairment of HRQOL and psychosocial factors yet. Aim To assess predictors for, and the impairment of, HRQOL in CLD and FD. Methods In 181 functional dyspepsia (FD) patients, 204 CLD patients and 337 healthy blood donors, HRQOL was assessed with the Short Form-36 (mental and physical component), and anxiety and depression utilizing the Hospital Anxiety and Depression Scale. Results Compared with HC, HRQOL is significantly lower in FD and CLD (P-value for all

In a consecutive cross-sectional study 195 Turkish/Kurdish patients from seven general practices (40.5 +/- 13.3 years, 63.6 % female) were examined with regard to traumatisation and psychological distress with the Essen Trauma Inventory (ETI) and Hospital Anxiety and Depression Scale (HADS). In mean the average duration of living in Germany was 25,3 years (SD = 8.9). 53.3 % reported at least one traumatic event in their life. Of those who experienced a traumatic event, 19.6 % met testpsychometric a positive diagnosis of PTSD. In general, patients with PTSD were more likely to report more about doctor visits (p

The protection of the donors from physical or emotional harm has been a fundamental principle in living-donor liver donation from the beginning. Psychosomatic donor evaluation aims at the selection of eligible donors and the screening and exclusion of psychiatrically vulnerable donors. As clinical interviews may include subjective biases, efforts should be made to establish objective criteria for donor assessment. In recent research, protective factors have been reported to be a significant force behind healthy adjustment to life stresses and can be investigated as possible predictors of donors' eligibility. Being the central construct of Antonovsky's theory of salutogenesis, the sense of coherence is one of the most surveyed protective factors and a good predictor of individuals' stability when experiencing stress. Furthermore, family support has been shown to be a valuable protective resource in coping with stress. This study surveyed whether sense of coherence and social support predict donors' emotional strain prior to transplantation. Seventy-one donor candidates were included in the study during the donor evaluation prior to living-donor liver transplantation. Sense of coherence proved to be a significant predictor for all criterion variables, namely anxiety, depression and mental quality of life. In addition to this, donor candidates who were classified as eligible for donation in the psychosomatic interview had significantly higher values on sense of coherence total scores compared with rejected donors. In a multiple regression analysis, sense of coherence and social support together yielded a prediction of depression with an explained variance of 22% (R(2) = 0.22). Sense of coherence and social support can be implemented as self-rating instruments in the psychosomatic selection of donors and would help to further objectify donors' eligibility.

We aim to assess the prevalence and severity of posttraumatic stress disorder (PTSD) in patients who receive long-term hemodialysis (HD) and investigate its correlation with depression, anxiety, health-related quality of life, and service utilization.In a cross-sectional study, we recruited 144 HD patients (age, 63.1 +/- 14.2 years; 50.7% men) from 5 dialysis units.PTSD, defined in accordance with criteria of the Impact of Event Scale-Revised and Posttraumatic Stress Diagnostic Scale.Physical health, mental health, depression, anxiety, life satisfaction, service utilization.Impact of Event Scale-Revised, Posttraumatic Stress Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-Form Health Survey.77.8% of HD patients reported at least 1 traumatic event. The lifetime prevalence for PTSD, independent from trauma type, was 17%. PTSD prevalence only with regard to HD as a potential traumatic event was 10.4%. Women reported more helplessness and more intensive experiences of fear or horror than men with respect to the stressor A criterion. Patients with PTSD showed substantial decreases in mental health in comparison to patients without PTSD (P0.01). Additionally, greater depression, anxiety, less life satisfaction, and more service utilization were associated with greater posttraumatic symptoms. There was no correlation of physical health with posttraumatic symptoms. In partial correlation analyses adjusting for depression, associations between posttraumatic symptoms, mental health, and anxiety remained robust.Generalizability to other settings, absence of control group, study power.PTSD is common in HD patients, but little work has been done to explore the variables associated with PTSD. Data suggest that PTSD is underdiagnosed and undertreated in HD patients. Interventions should target these patients with the goal to improve well-being and quality of life.