Die Kunst und Wissenschaft der Psychotherapie

Besser als jedes Lehrbuch es vermöchte, spiegelt dieses Buch den aktuellen Diskurs in der wissenschaftlichen Psychotherapie aus einer entspannten Haltung heraus wider. Die Herausgeber versammeln darin die Texte internationaler Experten aus Europa und den USA. Es geht in diesem Band u.a. um Beziehungen, Einsicht, «Responsive ness» oder die neurobiologische Begründung der Psychotherapie.

Emergency referrals for syncopes - is an ambulatory treatment safe?

Patients after syncopy arrive frequently in an emergency unit. Two scoring systems have been validated for clinical decision making, use of diagnostic methods and need for hospitalisation. Goal of the study was quality control of ambulatory treatment of syncope patients in a University Emergency Department. 200 consecutive patients with syncope were documented, 109 of whom followed by phone-call during two years. The decision for hospitalisation or ambulatory treatment was up to the treating doctor. Age-distribution was biphasic: female sex mainly below the age 25, from 55 to 75 predominantly men. Etiology of syncope remained unclear for the majority of cases, a few neurologic (n=3) or cardiac (n=5) reasons were found with treatment consequences.

Pflegende Angehörige älterer Menschen. Probleme, Bedürfnisse, Ressourcen und Zusammenarbeit mit der ambulanten Pflege

Dieser Frage geht das erfahrene Forscherteam um Pasqualina Perrig-Chiello und François Höpflinger in einer aufwendigen Schweizer Studie nach, in der sie- die demographischen, epidemiologischen und gesellschaftlichen Entwicklungen beschreiben und analysieren, die die Angehörigenpflege gegenwärtig und zukünftig beeinflussen- analysieren wer, wie, warum und unter welchen Be- und Entlastungen die familiale Hilfe und Pflege leistet- Entlastungsnotwendigkeiten für pflegende Angehörige begründen und Entlastungsmöglichkeiten durch die spitalexterne Versorgung und Familiengesundheitspflege in ambulanten und teilstationären Angeboten aufzeigen- zukünftige Entwicklungen der informellen und ambulanten Pflege im Alter, Trends und Szenarien sowie Handlungsfelder skizzieren und prognostizieren.

Psychotherapie und Neuroökonomie

Es gibt zunehmend Beispiele, die belegen, dass die Neuroökonomie als Kombination von ökonomischer Entscheidungstheorie und Neurowissenschaften einen wichtigen Beitrag zur Psychotherapie-Forschung leisten kann. Die Berührungspunkte der beiden Disziplinen sind vielfältig: • Neuroökonomie benutzt Verhaltensexperimente, die es erlauben, komplexes menschliches Verhalten zu untersuchen. Psychotherapie verändert komplexes menschliches Verhalten. Zur Verbesserung der Diagnostik und der Evaluation von Therapieergebnissen können einfache neuroökonomische Experimente einen wichtigen Beitrag leisten. Die experimentelle Messung von zeitlichen, sozialen und Unsicherheitspräferenzen ist besonders geeignet, psychische Störungen zu charakterisieren. • Neuroökonomie ist eine Wissenschaft der menschlichen Motivation. Das Verständnis von bewussten und unbewussten Motivationsfaktoren erlaubt es Psychotherapeutinnen, die Komplexität und Tiefe der Probleme ihrer Patientinnen zu erfassen. • Neuroökonomie ist eine Sozialwissenschaft. Beziehungsprobleme gehören zu den häufigsten Klagen von Patientinnen mit psychischen Störungen, soziale Stressoren sind wichtige Ursachen psychischer Störungen und die therapeutische Beziehung ist der wichtigste Wirkfaktor der Psychotherapie. Die neuroökonomische Erforschung des Sozialverhaltens kann deshalb die Psychotherapie auf unterschiedlichen Ebenen inspirieren. • Neuroökonomie ist eine Neurowissenschaft. Psychotherapie-Forschung beschäftigt sich zunehmend mit Neuroplastizität, insbesondere mit den Effekten von Psychotherapie auf die Funktion und die Struktur des Gehirns. Der neuroökonomische Forschungsansatz macht es möglich, komplexe neuronale Funktionsstörungen bei psychischen Krankheiten zu identifizieren und ihre Modifikation durch Psychotherapie sichtbar zu machen. • Neuroökonomie ist eine umfassende Wissenschaft des menschlichen Verhaltens. Moderne Psychotherapie hat den Anspruch, psychische Störungen auf dem Hintergrund eines bio-psycho-soziales Krankheitsmodells zu verstehen und zu behandeln. Die Neuroökonomie kann einen Beitrag leisten, psychotherapeutische Krankheitsmodelle wissenschaftlich zu fundieren. Die ökonomische Entscheidungstheorie ermöglicht es, die Wechselwirkungen und Synergien von psychotherapeutischer Arbeit, somatischen Behandlungen und sozialen Rahmenbedingungen abzuschätzen. Folgende Eigenschaften schränken die Anwendbarkeit von neuroökonomischen Ansätzen in der Psychotherapie-Forschung allerdings ein: • Das Präferenz-Konzept geht von einer stabilen Verhaltensprädisposition aus. Wechsel von Präferenzen und stark situationsabhängiges Verhalten kann nur beschränkt modelliert werden. • In den meisten neuroökonomischen Experimenten wird Geld als allgemein gültiger Anreiz verwendet. Diese Methodik erlaubt es nicht, reizspezifisches Verhalten zu untersuchen. • Die Neuroökonomie abstrahiert soziale Beziehungen, um sie wissenschaftlich fassbar zu machen. Gewisse Beziehungsaspekte wie beispielsweise die Rolle von Gestik und Mimik können mit dieser Methodik nicht untersucht werden. • Die klassische ökonomische Entscheidungstheorie ist besonders geeignet, „kalte“, überlegte Entscheidungen zu verstehen. Impulsives und zeitinkonsistentes Verhalten kann mit dieser Theorie nur ungenügend beschrieben werden. Neuroökonomie ist eine junge Wissenschaft mit grossem Entwicklungspotential. Führende theoretische und Experimentalökonomen sind daran, Theorie und Forschungsmethodik zu erweitern, um situations- und reizspezifische Faktoren besser zu berücksichtigen und das „heisse“ Ende des Spektrums von Entscheidungsfindungen besser zu verstehen.

[Gender differences in acute and chronic pain conditions. Implications for diagnosis and therapy].

Gender differences can influence incidence and outcome of acute and chronic pain conditions. The reasons are to be found in genetic factors, hormonal effects and differences in anatomy and physiology. Furthermore differences relating to psychiatric comorbidities (i.e. depression) and psychosocial factors (roles, coping strategies) have been demonstrated. Men and women differ in the response to drugs and other treatments. They are differently affected by side effects of drugs. There is a gender bias in diagnosis and therapy. There is a need to study the influence of gender, age and race in order to optimize treatment towards a more individualized therapy. This article highlights already identified differences.

Evidence from the real world: N-15 natural abundances reveal enhanced nitrogen use at high plant diversity in Central European grasslands

Complementarity that leads to more efficient resource use is presumed to be a key mechanism explaining positive biodiversity–productivity relationships but has been described solely for experimental set-ups with controlled environmental settings or for very short gradients of abiotic conditions, land-use intensity and biodiversity. Therefore, we analysed plant diversity effects on nitrogen dynamics across a broad range of Central European grasslands. The 15N natural abundance in soil and plant biomass reflects the net effect of processes affecting ecosystem N dynamics. This includes the mechanism of complementary resource utilization that causes a decrease in the 15N isotopic signal. We measured plant species richness, natural abundance of 15N in soil and plants, above-ground biomass of the community and three single species (an herb, grass and legume) and a variety of additional environmental variables in 150 grassland plots in three regions of Germany. To explore the drivers of the nitrogen dynamics, we performed several analyses of covariance treating the 15N isotopic signals as a function of plant diversity and a large set of covariates. Increasing plant diversity was consistently linked to decreased δ15N isotopic signals in soil, above-ground community biomass and the three single species. Even after accounting for multiple covariates, plant diversity remained the strongest predictor of δ15N isotopic signals suggesting that higher plant diversity leads to a more closed nitrogen cycle due to more efficient nitrogen use. Factors linked to increased δ15N values included the amount of nitrogen taken up, soil moisture and land-use intensity (particularly fertilization), all indicators of the openness of the nitrogen cycle due to enhanced N-turnover and subsequent losses. Study region was significantly related to the δ15N isotopic signals indicating that regional peculiarities such as former intensive land use could strongly affect nitrogen dynamics. Synthesis. Our results provide strong evidence that the mechanism of complementary resource utilization operates in real-world grasslands where multiple external factors affect nitrogen dynamics. Although single species may differ in effect size, actively increasing total plant diversity in grasslands could be an option to more effectively use nitrogen resources and to reduce the negative environmental impacts of nitrogen losses.

Localization of impacted maxillary canines and root resorption of neighbouring teeth: a study assessing the diagnostic value of panoramic radiographs in two groups of observers.

OBJECTIVES To assess the diagnostic value of panoramic views (2D) of patients with impacted maxillary canines by a group of trained orthodontists and oral surgeons, and to quantify the subjective need and reasons for further three-dimensional (3D) imaging. MATERIALS AND METHODS The study comprises 60 patients with panoramic radiographs (2D) and cone beam computed tomography (CBCT) scans (3D), and a total of 72 impacted canines. Data from a standardized questionnaire were compared within (intragroup) and between (intergroup) a group of orthodontists and oral surgeons to assess possible correlations and differences. Furthermore, the questionnaire data were compared with the findings from the CBCT scans to estimate the correlation within and between the two specialties. Finally, the need and reasons for further 3D imaging was analysed for both groups. RESULTS When comparing questionnaire data with the analysis of the respective CBCT scans, orthodontists showed probability (Pr) values ranging from 0.443 to 0.943. Oral surgeons exhibited Pr values from 0.191 to 0.946. Statistically significant differences were found for the labiopalatal location of the impacted maxillary canine (P = 0.04), indicating a higher correlation in the orthodontist group. The most frequent reason mentioned for the further need of 3D analysis was the labiopalatal location of the impacted canines. Oral surgeons were more in favour of performing further 3D imaging (P = 0.04). CONCLUSIONS Orthodontists were more likely to diagnose the exact labiopalatal position of impacted maxillary canines when using panoramic views only. Generally, oral surgeons more often indicated the need for further 3D imaging.

A Swiss paradox? Higher income inequality of municipalities is associated with lower mortality in Switzerland.

It has long been surmised that income inequality within a society negatively affects public health. However, more recent studies suggest there is no association, especially when analyzing small areas. This study aimed to evaluate the effect of income inequality on mortality in Switzerland using the Gini index on municipality level. The study population included all individuals >30 years at the 2000 Swiss census (N = 4,689,545) living in 2,740 municipalities with 35.5 million person-years of follow-up and 456,211 deaths over follow-up. Cox proportional hazard regression models were adjusted for age, gender, marital status, nationality, urbanization, and language region. Results were reported as hazard ratios (HR) with 95 % confidence intervals. The mean Gini index across all municipalities was 0.377 (standard deviation 0.062, range 0.202-0.785). Larger cities, high-income municipalities and tourist areas had higher Gini indices. Higher income inequality was consistently associated with lower mortality risk, except for death from external causes. Adjusting for sex, marital status, nationality, urbanization and language region only slightly attenuated effects. In fully adjusted models, hazards of all-cause mortality by increasing Gini index quintile were HR = 0.99 (0.98-1.00), HR = 0.98 (0.97-0.99), HR = 0.95 (0.94-0.96), HR = 0.91 (0.90-0.92) compared to the lowest quintile. The relationship of income inequality with mortality in Switzerland is contradictory to what has been found in other developed high-income countries. Our results challenge current beliefs about the effect of income inequality on mortality on small area level. Further investigation is required to expose the underlying relationship between income inequality and population health.

Treatment and outcomes of urethral recurrence of urinary bladder cancer in women after radical cystectomy and orthotopic neobladder: a series of 12 cases

INTRODUCTION The incidence, treatment, and outcome of urethral recurrence (UR) after radical cystectomy (RC) for muscle-invasive bladder cancer with orthotopic neobladder in women have rarely been addressed in the literature. PATIENTS AND METHODS A total of 12 patients (median age at recurrence: 60 years) who experienced UR after RC with an orthotopic neobladder were selected for this study from a cohort of 456 women from participating institutions. The primary clinical and pathological characteristics at RC, including the manifestation of the UR and its treatment and outcome, were reviewed. RESULTS The primary bladder tumors in the 12 patients were urothelial carcinoma in 8 patients, squamous cell carcinoma and adenocarcinoma in 1 patient each, and mixed histology in 2 patients. Three patients (25%) had lymph node-positive disease at RC. The median time from RC to the detection of UR was 8 months (range 4-55). Eight recurrences manifested with clinical symptoms and 4 were detected during follow-up or during a diagnostic work-up for clinical symptoms caused by distant metastases. Treatment modalities were surgery, chemotherapy, radiotherapy, and bacillus Calmette-Guérin urethral instillations. Nine patients died of cancer. The median survival after the diagnosis of UR was 6 months. CONCLUSIONS UR after RC with an orthotopic neobladder in females is rare. Solitary, noninvasive recurrences have a favorable prognosis when detected early. Invasive recurrences are often associated with local and distant metastases and have a poor prognosis. © 2014 S. Karger AG, Basel.

Patterns of Psychological Adaptation to Spousal Bereavement in Old Age

Background: While the negative effects of spousal bereavement on well-being are well documented in empirical research, the large individual differences in psychological adaptation are still not well understood. Objective: This contribution aims to identify patterns of psychological adaptation to spousal loss in old age and to shed light on the role of intra- and interpersonal resources and contextual factors as discriminant variables among these patterns. Methods: The data stem from a cross-sectional questionnaire study of 402 widowed individuals (228 women, 174 men) aged between 60 and 89 years (mean age 74.41 years), who lost their partner within the last 5 years, and 618 married individuals, who served as controls (312 women, 306 men; mean age 73.82 years). Results: The exploratory latent profile analysis of the well-being outcomes of depressive symptoms, hopelessness, loneliness, life satisfaction and subjective health revealed three different groups in the widowed sample: ‘resilients' (54% of the sample), ‘copers' (39%) and ‘vulnerables' (7%). The most important variables for group allocation were intrapersonal resources - psychological resilience and the Big Five personality traits - but also the quality of the former relationship and how the loss was experienced. Conclusion: Successful adaptation to spousal loss is primarily associated with high scores in psychological resilience and extraversion and low scores in neuroticism. Our results shed light on the variability in psychological adaptation and underline the important role of intrapersonal resources in facing spousal loss in old age.