[Medical students' attitudes towards mental illness: a matter of studies or personality?]

Stigmatization of mental illness is a widespread phenomenon even among health professionals. To explore the origins of this inappropriate attitude, medical students at the beginning and in the end of their studies were examined with self-report measures of social distance towards mentally ill persons, beliefs about etiology of mental disorders, valuation of psychotherapy and the personality features empathy and narcissism. While the students' attitudes turn out to be unrelated to the personality features, significant differences between the two groups were found indicating that distance towards mentally ill patients in the medical role and ambivalence about the etiological factors of mental disorders are stronger pronounced in the end of the studies compared to the beginning. These findings underline the need to prepare medical students better for contacts with mentally ill patients.

Student Evaluation Scale for Medical Courses with Simulations of the Doctor-Patient Interaction (SES-Sim)

Objective: Simulations of doctor-patient interactions have become a popular method for the training of medical skills, primarily communication skills. A new questionnaire for the measurement of students’ satisfaction with medical courses using this technique is presented, the Student Evaluation Scale for Medical Courses with Simulations of the Doctor-Patient Interaction (SES-Sim).

Method: A set of items focusing on the course quality and the core elements of simulations was created and presented to 220 medical students who had been trained with this method.

Results: Based on factor-analyses 18 items were selected for the final version of the scale, which represent five dimensions: learning success, actors, premises, tutors and students. The five dimensions are all significantly correlated with a 1-item-measure of the general satisfaction with the course.

Conclusion: The SES-Sim enables tutors to assess in an economic way whether the course has met the students’ needs and what can be done better.

A stepwise psychotherapy intervention for reducing risk in coronary artery disease (SPIRR-CAD) - rationale and design of a multicenter, randomized trial in depressed patients with CAD

OBJECTIVE

Depressive symptoms are highly relevant for the quality of life, health behavior, and prognosis in patients with coronary artery disease (CAD). However, previous psychotherapy trials in depressed CAD patients produced small to moderate effects on depression, and null effects on cardiac events. In this multicentre psychotherapy trial, symptoms of depression are treated together with the Type D pattern (negative affectivity and social inhibition) in a stepwise approach.

METHODS

Men and women (N=569, age 18-75 years) with any manifestation of CAD and depression scores ≥ 8 on the Hospital Anxiety and Depression Scale (HADS), will be randomized (allocation ratio 1:1) into the intervention or control group. Patients with severe heart failure, acutely life-threatening conditions, chronic inflammatory disease, severe depressive episodes or other severe mental illness are excluded. Both groups receive usual medical care. Patients in the intervention group receive three initial sessions of supportive individual psychotherapy. After re-evaluation of depression (weeks 4-8), patients with persisting symptoms receive an additional 25 sessions of combined psychodynamic and cognitive-behavioral group therapy. The control group receives one psychosocial counseling session. Primary efficacy variable is the change of depressive symptoms (HADS) from baseline to 18 months. Secondary endpoints include cardiac events, remission of depressive disorder (SCID) and Type D pattern, health-related quality of life, cardiovascular risk profile, neuroendocrine and immunological activation, heart rate variability, and health care utilization, up to 24 months of follow-up (ISRCTN: 76240576; NCT00705965). Funded by the German Research Foundation.

Psychological and social factors in coronary heart disease

More than six decades of empirical research have shown that psychosocial risk factors like low socio-economic status, lack of social support, stress at work and family life, depression, anxiety, and hostility contribute both to the risk of developing coronary heart disease (CHD) and the worsening of clinical course and prognosis in patients with CHD. These factors may act as barriers to treatment adherence and efforts to improve life-style in patients and populations. In addition, distinct psychobiological mechanisms have been identified, which are directly involved into the pathogenesis of CHD. In clinical practice, psychosocial risk factors should be assessed by clinical interview or standardized questionnaires, and relevance with respect to quality of life and medical outcome should be discussed with the patient. In case of elevated risk, multimodal, behavioural intervention, integrating counselling for psychosocial risk factors and coping with illness, should be prescribed. In case of clinically significant symptoms of depression and anxiety, patients should be referred for psychotherapy, and/or medication according to established standards (especially selective serotonin reuptake inhibitors (SSRIs)) should be prescribed. Psychotherapy and SSRIs appear to be safe and effective with respect to emotional disturbances; however, a definite beneficial effect on cardiac end-points has not been documented.

Prevalence of cardiovascular risk factors in middle-aged type 2 diabetic automobile employees assessed at the workplace--the Praeford study

OBJECTIVE

The purpose of this study was to provide contemporary data on the prevalence of cardiovascular risk factors in middle-aged diabetic employees in Germany.

METHODS

Cardiovascular risk factors were assessed at the workplace in employees of the automobile industry who identified themselves as having type 2 diabetes mellitus. The proportion of subjects reaching the target values for hemoglobin A1c (HbA1c), systolic blood pressure, and low-density lipoprotein (LDL) cholesterol was analyzed.

RESULTS

Among 4234 employees, 91 employees with diabetes were identified (mean age, 52 years). Only 7 of 91 (8%) diabetic employees achieved all three recommended target values. Blood pressure targets were achieved by 26%, HbA1c target value by 54%, and LDL target value by 31% of employees.

CONCLUSION

Only a negligible proportion of working people with diabetes achieve the recommended target values. This sobering result questions current management modalities and calls for new treatment and monitoring strategies for working people with diabetes.

[Diabetes and depression--a life-endangering interaction]

In the past decade, research has increasingly discovered the relevance of depressive symptoms for the development and course of diabetes, particularly in diabetes type 2. The present paper provides an update on the present state of empirical research concerning this question.One fourth of all patients with diabetes mellitus suffer from depressive symptoms up to and including states of depressive disorders. The studies reviewed advise that depression in patients with diabetes concur with an unfavourable attitude towards the illness as well as towards treatment, a reduction in quality of life, an increased risk for the development of follow-up diseases as well as an increase in mortality risk. As a cause for the increasing risk in morbidity and mortality in depressive patients with diabetes, both neuroendocrinologic changes as well as unfavourable therapy and illness attitudes are discussed. First studies document that psychotherapeutic interventions are helpful in increasing the quality of life of depressive patients with diabetes and improving therapy behaviour.

Ess-Störungen und Diabetes mellitus

Adoleszente und junge Frauen mit Typ 1-Diabetes mellitus zeigen eine überzufällige Koinzidenz mit der Bulimia nervosa. Aber auch die Prävalenz von Ess-Störungen, die nicht alle Kriterien der Bulimia nervosa erfüllen, ist im Vergleich zu Frauen dieser Altersgruppe ohne Diabetes mellitus erhöht. Die Komorbidität von Typ 1-Diabetes und einer Ess-Störung stellt einen Risikofaktor für die Entwicklung späterer diabetischer Folgeerkrankungen dar. So zeichnen sich essgestörte PatientInnen mit Typ 1-Diabetes durch eine unzureichende Stoffwechselkontrolle und die frühzeitigere Entwicklung von diabetischen Spätschäden wie der Retinopathie aus. Die Binge Eating-Störung, eine zunächst unter Forschungsgesichtspunkten definierte neue Ess-Störungsentität ist insbesondere bei Übergewicht und Adipositas zu beobachten. Auch wenn die Binge Eating-Störung bei Menschen mit Typ 2-Diabetes im Vergleich zu stoffwechselgesunden Menschen nicht häufiger auftritt, stellt sie doch einen Risikofaktor für eine akzellerierte Gewichtszunahme dar, welche in der Regel mit einer Zunahme der Insulinresistenz einhergeht.