Treatment Changes in General Practice Patients With Chronic Mental Disorders Following a Psychiatric-Psychosomatic Consultation

[Participation-oriented psychotherapy for patients with mental disorders who are able or unable to work : Results of a survey of practicing psychotherapists]

BACKGROUND

Treatment of (chronic) mental disorders must focus on both reducing symptoms and improving social and work participation by social medicine treatments and counselling. The objective of this study was to compare psychotherapy patients who are fit or unfit for work to describe similarities and differences regarding patient status and interventions.

METHODS

Interviews were performed with 73 cognitive behavior therapists and 58 psychodynamic psychotherapists about 188 and 134 recent cases they had seen, respectively. The case reports referred to patients who were on average 42 years old (65% females).

RESULTS

There were no differences between patients with no or short-term sick leave (up to 6 weeks, n = 156) and patients with longer sick leave (7 weeks or more, n = 140) with respect to basic characteristics of treatment (side effects, therapeutic alliance). Patients with a longer sick leave duration had more severe capacity and participation impairments and received more specific work participation-oriented treatments, whereas general saluto-therapeutic activities (sports-club, counselling, family-support) were similarly undertaken in patients with shorter or longer sick leave.

DISCUSSION

Therapists chose intervention options according to indication: in patients with work participation problems, more work-related treatments are undertaken, whereas interventions for general mental health improvement are distributed independent of specific work participation problems.

Needs, expectations, facilitators, and barriers among insurance physicians related to the use of eHealth in their work: results of a survey

PURPOSE

To determine needs, expectations, facilitators, and barriers of insurance physicians (IPs) for using eHealth in their work. Also, we investigated differences between age groups.

MATERIALS AND METHODS

All insurance physicians employed at the Dutch Social Security Institute (SSI) received an online anonymous survey in July 2020.

RESULTS

Three hundred and fifteen IPs (31%) responded. According to these IPs, the most important need for using eHealth was to collect medical information more effectively and efficiently (71%).Main facilitators were that eHealth could make IPs' work more effectively and efficiently (61%) and more future-proof (60%). Main barriers were losing human interaction (54%) and security issues (51%). Younger IPs saw more options for using eHealth, compared to older IPs.

CONCLUSIONS

The majority of IPs (in particular younger IPs) had a positive view towards using eHealth in their daily work. Nevertheless, differences in needs, expectations, facilitators and barriers between the age groups should be taken into account for the successful development and implementation of interventions using eHealth in insurance medicine.

Health Status Stability of Patients in a Medical Rehabilitation Program: What Are the Roles of Time, Physical Fitness Level, and Self-efficacy?

BACKGROUND

Individuals' physical and mental health, as well as their chances of returning to work after their ability to work is damaged, can be addressed by medical rehabilitation.

AIM

This study investigated the developmental trends of mental and physical health among patients in medical rehabilitation and the roles of self-efficacy and physical fitness in the development of mental and physical health.

DESIGN

A longitudinal design that included four time-point measurements across 15 months.

SETTING

A medical rehabilitation center in Germany.

POPULATION

Participants included 201 patients who were recruited from a medical rehabilitation center.

METHODS

To objectively measure physical fitness (lung functioning), oxygen reabsorption at anaerobic threshold (VO2AT) was used, along with several self-report scales.

RESULTS

We found a nonlinear change in mental health among medical rehabilitation patients. The results underscored the importance of medical rehabilitation for patients' mental health over time. In addition, patients' physical health was stable over time. The initial level of physical fitness (VO2AT) positively predicted their mental health and kept the trend more stable. Self-efficacy appeared to have a positive relationship with mental health after rehabilitation treatment.

CONCLUSIONS

This study revealed a nonlinear change in mental health among medical rehabilitation patients. Self-efficacy was positively related to mental health, and the initial level of physical fitness positively predicted the level of mental health after rehabilitation treatment.

CLINICAL REHABILITATION

More attention could be given to physical capacity and self-efficacy for improving and maintaining rehabilitants' mental health.

Patients Characteristics and Psychosocial Treatment in Psychodynamic and Cognitive Behavior Therapy

Introduction: The most prevalent psychotherapy schools are psychodynamic (PDT) and cognitive behavior therapy (CBT). There are no scientific guidelines on which type of patient should be treated by which therapist, and how they can find the best one. Part of the answer can be derived from data on who is treated in which way. Objective: Objective of this study was to compare patients in routine PDT and CBT to describe similarities and differences in regard to patient status and treatment. Materials and Methods: A research psychotherapist visited 73 cognitive behavior therapists and 58 psychodynamic psychotherapists in their office and asked them to report about the last cases they had seen. There were 188 CBT and 134 PD case reports. Results: There were no significant differences in socio-demographics between PDT and CBT patients. The average number of treatment session so far was significantly higher in PDT than CBT. There were longer duration of illness, more parallel medical treatments and higher rates of sick leave in CBT patients. While assessment of capacities with the Mini-ICF-APP showed no differences, more participation restrictions were found in CBT patients. Correspondingly there were more sociomedical interventions, especially in regard to work. Conclusions: The differences between PDT and CBT may be explained by the fact that PDT requires analytical capabilities on the side of the patient, which may exclude patients with social problems, while CBT is coping oriented which allows the inclusion of all kinds of patients. Still, in both treatment modes, complex patients are treated with multidimensional interventions.

Sozialmedizinische Interventionen in der Richtlinienpsychotherapie

Hintergrund

Viele psychische Störungen nehmen einen Langzeitverlauf und gehen daher mit sozialen und beruflichen Teilhabeeinschränkungen einher. Dies gilt auch für Patienten in der Richtlinienpsychotherapie. Um eine ganzheitliche Versorgung zu gewährleisten, sind u. a. sozialmedizinische Interventionen erforderlich, wozu die Koordinierung mit anderen Therapeuten, Kontakte zum Arbeitgeber oder zu arbeitsrelevanten Institutionen, häusliche und freizeitbezogene Hilfen oder soziale Unterstützungsmaßnahmen gehören. Es stellt sich die Frage, welche derartigen sozialmedizinischen Interventionen zum Repertoire von Richtlinienpsychotherapeuten in ihrem Arbeitsalltag gehören.

Material und Methoden

Es wurden 131 psychologische Psychotherapeuten gebeten, anhand eines Glossars mit 38 sozialmedizinischen Interventionen anzugeben, welche davon sie in ihrer täglichen Praxis anwenden.

Ergebnisse

Alle Maßnahmen kamen zur Anwendung. Im Durchschnitt gaben die Therapeuten an, dass ihnen von den 38 Interventionen eine nicht bekannt war, sie mit ca. 14 Interventionen nach eigener Einschätzung nie, mit 8 weniger als einmal/Jahr, mit 8 einmal/Jahr und mit 6 einmal/Quartal befasst waren.

Schlussfolgerung

Die vorliegenden Daten zeigen, dass sozialmedizinische Interventionen zum Repertoire vieler Psychotherapeuten gehören. Allerdings finden sich Unterschiede zwischen den Therapeuten, hinsichtlich des Bekanntheitsgrads und der Anwendung sozialmedizinischer Interventionen. Das weist auf Optimierungspotenziale in der Ausbildung, Organisation und Vergütung hin.