[Training in iterative hypothesis testing as part of psychiatric education. A randomized study]

BACKGROUND

The improvement of medical education is at the center of efforts to reform the studies of medicine. Furthermore, an excellent teaching program for students is a quality feature of medical universities. Besides teaching of disease-specific contents, the acquisition of interpersonal and decision-making skills is important. However, the cognitive style of senior physicians leading to a diagnosis cannot easily be taught. Therefore, the following study aimed at examining whether specific training in iterative hypothesis testing (IHT) may improve the correctness of the diagnostic process.

MATERIALS AND METHODS

Seventy-one medical students in their 9th-11th terms were randomized to medical teaching as usual or to IHT training for 4 weeks. The intervention group received specific training according to the method of IHT. All students were examined by a multiple choice (MC) exam and additionally by simulated patients (SP). The SPs were instructed to represent either a patient with depression and comorbid anxiety and substance use disorder (SP1) or to represent a patient with depression, obsessive-compulsive disorder and acute suicidal tendencies (SP2).

RESULTS

All students identified the diagnosis of major depression in the SPs, but IHT-trained students recognized more diagnostic criteria. Furthermore, IHT-trained students recognized acute suicide tendencies in SP2 more often and identified more comorbid psychiatric disorders. The results of the MC exam were comparable in both groups. An analysis of the satisfaction with the different training programs revealed that the IHT training received a better appraisal.

CONCLUSIONS

Our results point to the role of IHT in teaching diagnostic skills. However, the results of the MC exam were not influenced by IHT training. Furthermore, our results show that students are in need of training in practical clinical skills.

["Help Conference", a new social assistance for integration according to § 53 SGB XII--a two-year analysis]

OBJECTIVE

To deal with applications for social assistance for integration according to § 53 SGB XII, in the district of Hannover a so called "Help Conference" was introduced. Since implementation of "Help Conferences", the number of applications has increased by about 1,100% over the past five years. We analysed whether a change from the institutional help system to more individual "help" has already been realised.

METHODS

"Help Conferences" recorded between 2005 and 2006 were evaluated in regard to demographic and medical data. 78 of 202 protocols (40%) had been filled in completely and thus could be included in our evaluation.

RESULTS

37 patients (47%) had F2 spectrum diagnoses according to ICD-10. More than one third of our patients (31 patients=40%) were male patients with a diagnosis of addiction, whereas in this study female patients were rarely affected by addiction (5 patients=6%). The first application was filed by the hospital social service in most cases. Applications submitted by the patients themselves were an exception. 46 applications (59%) were follow-ups, submitted by the institution responsible for the patient.

CONCLUSIONS

The new system is focused on the individual interests of patients and implicates an improved and more predictable aftercare in patients with psychiatric diseases.

Varenicline for the Treatment of Nightmares and Sleep Disturbance in Patients with Post-traumatic-stress-disorder (PTSD) - Two Case Reports

Aims:

Varenicline is a drug used for smoking withdrawal symptoms. It reduces cravings by binding to alpha4-beta2-nicotine-acethylcholine-receptors of the central nervous system. Side effects are nausea, headache, sleeping disorders. Patients with PTSD complain of depressions, social isolation, insomnia, nightmares and flashbacks. These symptoms often cause a severe drug abuse. We present two patients complaining of sleeping disorders caused by nightmares. These symptoms were significantly reduced under treatment with Varenicline due to a nicotine abuse.

Method:

Patient A was a woman with a history of sexual abuse in childhood. Besides a drug abuse of benzodiazepines she presented a nicotine addiction. She was increasingly affected by nightmares and insomnia. Patient B was a woman, who grew up in a children's protectory, where she was involved in violence. A PTSD was accompanied by alcohol and benzodiazepine abuse. The PTSD caused episodes of depression with suicidal ideation, nightmares and insomnia.

Results:

Both patients were treated with Varenicline for smoking cessation. After few days of treatment, they reported improved sleeping behaviours and diminished nightmares.

Conclusion:

Currently only few studies confirm the effectiveness of alpha1-receptor-agonists (Prazosin) in PTSD-associated nightmares. Our case reports demonstrated the effectiveness of Vareniclin in the treatment of nightmares and sleeping disorders in two patients. The treatment with Vareniclin lead to modified dreaming behaviours with positive, less threatening dreams. Therefore a placebo-controlled study to assess the effectiveness of Vareniclin in the treatment of nightmares is necessary.