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van Houten J, Bouwmeester S, Bachrach N. Effectiveness of Day Treatment Group Schema Therapy for Personality Disorders: A Multiple Baseline Single-Case Study. Clin Psychol Psychother 2024; 31:e2964. [PMID: 38528762 DOI: 10.1002/cpp.2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Schema therapy is effective for most outpatients with personality disorders (PDs). However, a subgroup does not sufficiently benefit from outpatient programmes. Despite its common clinical use, a thorough evaluation of day treatment group schema therapy (GST) is lacking. AIMS This study aimed to investigate the effectiveness of day treatment GST for patients with PDs. METHODS AND PROCEDURES Negative core beliefs were the primary outcome in a multiple baseline single-case design, measured weekly before and during 30 weeks of day treatment GST. Secondary outcomes included severity of primary PD, early maladaptive schemas (EMS), schema modes and general psychopathology measured before and after day treatment GST. Intervention effects were evaluated through visual inspection and randomization test analysis, with a reliable change index calculated for the secondary outcome measures. OUTCOMES AND RESULTS A total of 79% of treatment completers showed a significant positive effect of day treatment GST with large effect sizes (Cohen's d: 0.96-10.04). Secondary outcomes supported these findings: 56% had a significant decrease in the severity of primary PD and 53% in general psychopathology. In addition, 63% of EMS and 72% of schema modes (87.5% for functional schema modes) showed significant positive reliable changes. CONCLUSIONS AND IMPLICATIONS This is the first empirical study that demonstrated the effectiveness of day treatment GST in patients with severe PDs. Day treatment GST can serve as a stepped care treatment option for nonresponsive patients in outpatient programmes. Further randomized controlled (cost-)effectiveness research is necessary to substantiate these findings and investigate the specific patient populations for which day treatment is essential.
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Affiliation(s)
- Joska van Houten
- Department of Trauma Related and Personality Disorders, GGZ Oost Brabant, Helmond, The Netherlands
| | - Samantha Bouwmeester
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Nathan Bachrach
- Department of Trauma Related and Personality Disorders, GGZ Oost Brabant, Helmond, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Mental Health Care Psychology, RINO Zuid, Eindhoven, The Netherlands
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Bever-Philipps A, Silbermann A, Morawa E, Schäflein E, Stemmler M, Erim Y. Long-term follow-up of a multimodal day clinic, group-based treatment program for patients with very high risk for complex posttraumatic stress disorder, and for patients with non-complex trauma-related disorders. Front Psychiatry 2023; 14:1152486. [PMID: 37398576 PMCID: PMC10311064 DOI: 10.3389/fpsyt.2023.1152486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/19/2023] [Indexed: 07/04/2023] Open
Abstract
Objective The present study examined the follow-up of a multimodal day clinic group-based therapy program for patients with trauma-related disorders and investigated potential differences for patients with classic PTSD versus cPTSD. Method Sixty-six patients were contacted 6 and 12 months after discharge of our 8-week program and completed various questionnaires (Essen Trauma Inventory (ETI), Beck Depression Inventory-Revised (BDI-II), Screening scale of complex PTSD (SkPTBS), Patient Health Questionnaire (PHQ)-Somatization, as well as single items to therapy utilization and life events in the interim period). Due to organizational reasons a control group could not be included. Statistical analyses included repeated-measures ANOVA with cPTSD as between-subject factor. Results The reduction of depressive symptoms at discharge was persistent at 6 and 12 months follow-up. Somatization symptoms were increased at discharge, but were leveled out at 6 months follow-up. The same effect was found for cPTSD symptoms in those patients with non-complex trauma-related disorders: Their increase of cPTSD symptoms was flattened at 6 months follow-up. Patients with a very high risk for cPTSD showed a strong linear reduction of cPTSD symptoms from admission to discharge and 6 months follow-up. cPTSD patients had a higher symptom load compared to patients without cPTSD on all time points and scales. Conclusion Multimodal, day clinic trauma-focused treatment is associated with positive changes even after 6 and 12 months. Positive therapy outcomes (reduced depression, reduced cPTSD symptoms for patients with a very high risk for cPTSD) could be maintained. However, PTSD symptomatology was not significantly reduced. Increases in somatoform symptoms were leveled out and can therefore be regarded as side effects of treatment, which may be connected with actualization of trauma in the intensive psychotherapeutic treatment. Further analyses should be applied in larger samples and a control group.
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Affiliation(s)
- Anke Bever-Philipps
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andrea Silbermann
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Morawa
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Schäflein
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mark Stemmler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Yesim Erim
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Enodien B, Moser D, Kessler F, Taha-Mehlitz S, Frey DM, Taha A. Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care. Int J Environ Res Public Health 2022; 19:12410. [PMID: 36231718 PMCID: PMC9566150 DOI: 10.3390/ijerph191912410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Medical progress is increasingly enabling more and more stationary treatment to be provided in the outpatient sector. This development should be welcomed, as healthcare costs have been rising for years. The design of efficient processes and a needs-based infrastructure enable further savings. According to international recommendations (EHS/IEHS), outpatient treatment of unilateral inguinal hernias is recommended. METHOD Data from patients in GZO Hospital Wetzikon/Zurich between 2019 and 2021 for unilateral inguinal hernia repair was included in this study (n = 234). Any over- or under-coverage correlated with one of the three treatment groups: stationary, partially stationary and patients treated in outpatients clinic. Complications and 30-day readmissions were also monitored. RESULTS Final revenue for all patients is -95.36 CHF. For stationary treatments, the mean shifts down to -575.01 CHF, for partially stationary treatments the mean shifts up to -24.73 CHF, and for patients in outpatient clinic final revenue is 793.12 CHF. This result is also consistent with the operation times, which are lowest in the outpatient clinic with a mean of 36 min, significantly longer in the partially stationary setting with 58 min, and longest in the stationary setting with 76 min. The same applies to the anesthesia times and the relevant care times by the nurses as the most important cost factors in addition to the supply and allocation costs. CONCLUSIONS We show that cost-effective elective unilateral inguinal hernia care in the outpatient clinic with profit (mean 793.12 CHF) is possible. Stationary unilateral hernia care (mean -575.01 CHF) is loss-making. Crucial factors for cost efficiency are optimized processes in the operating room (anesthesia, surgical technique and quality, operating time), as well as optimized care processes with minimal preoperative services and care times for the patient. However, at the same time, these optimizations pose a challenge to surgical and anesthesiology training and structures with high levels of preoperative and Postoperative services and pay-as-you-go costs. The complication rate is 0.91% lower than in a comparable study. The readmission within 30 days post-operation results with a positive deviation of -3.53% (stationary) and with a negative deviation of +2.29% (outpatient clinic) compared to a comparative study.
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Affiliation(s)
- Bassey Enodien
- Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
| | - Dominik Moser
- Operations Management, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
- Department of Health Care Management, Technical University of Berlin, 10623 Berlin, Germany
- Department of Economics and Technology, Swiss Distance University of Applied Sciences (FFHS), 8005 Zurich, Switzerland
- School of Medicine, University of St. Gallen, 9000 St. Gallen, Switzerland
| | - Florian Kessler
- Department of Anesthesiology, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
| | - Stephanie Taha-Mehlitz
- Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4058 Basel, Switzerland
| | - Daniel M. Frey
- Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Anas Taha
- Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, 4123 Allschwil, Switzerland
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Prell T, Siebecker F, Lorrain M, Tönges L, Warnecke T, Klucken J, Wellach I, Buhmann C, Wolz M, Lorenzl S, Herbst H, Eggers C, Mai T. Specialized Staff for the Care of People with Parkinson's Disease in Germany: An Overview. J Clin Med 2020; 9:E2581. [PMID: 32784969 DOI: 10.3390/jcm9082581] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Access to specialized care is essential for people with Parkinson´s disease (PD). Given the growing number of people with PD and the lack of general practitioners and neurologists, particularly in rural areas in Germany, specialized PD staff (PDS), such as PD nurse specialists and Parkinson Assistants (PASS), will play an increasingly important role in the care of people with PD over the coming years. PDS have several tasks, such as having a role as an educator or adviser for other health professionals or an advocate for people with PD to represent and justify their needs. PD nurse specialists have been established for a long time in the Netherlands, England, the USA, and Scandinavia. In contrast, in Germany, distinct PDS models and projects have been established. However, these projects and models show substantial heterogeneity in terms of access requirements, education, theoretical and practical skills, principal workplace (inpatient vs. outpatient), and reimbursement. This review provides an overview of the existing forms and regional models for PDS in Germany. PDS reimbursement concepts must be established that will foster an implementation throughout Germany. Additionally, development of professional roles in nursing and more specialized care in Germany is needed.
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Prell T, Siebecker F, Lorrain M, Eggers C, Lorenzl S, Klucken J, Warnecke T, Buhmann C, Tönges L, Ehret R, Wellach I, Wolz M. Recommendations for Standards of Network Care for Patients with Parkinson's Disease in Germany. J Clin Med 2020; 9:jcm9051455. [PMID: 32414071 PMCID: PMC7290836 DOI: 10.3390/jcm9051455] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 02/07/2023] Open
Abstract
Although our understanding of Parkinson’s disease (PD) has improved and effective treatments are available, caring for people with PD remains a challenge. The large heterogeneity in terms of motor symptoms, nonmotor symptoms, and disease progression makes tailored individual therapy and individual timing of treatment necessary. On the other hand, only limited resources are available for a growing number of patients, and the high quality of treatment cannot be guaranteed across the board. At this point, networks can help to make better use of resources and improve care. The working group PD Networks and Integrated Care, part of the German Parkinson Society, is entrusted to convene clinicians, therapists, nurses, researchers, and patients to promote the development of PD networks. This article summarizes the work carried out by the working group PD Networks and Integrated Care in the development of standards of network care for patients with PD in Germany.
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Affiliation(s)
- Tino Prell
- Department of Neurology, Jena University Hospital, 07740 Jena, Germany
- Center for Healthy Ageing, Jena University Hospital, 07740 Jena, Germany
- Correspondence:
| | | | - Michael Lorrain
- Nervenarztpraxis Gerresheim-Pempelfort, 40477 Düsseldorf, Germany;
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, 35037 Marburg, Germany;
| | - Stefan Lorenzl
- Professorship for Palliative Care, Paracelsus Medical University, 5020 Salzburg, Austria;
- Department of Palliative Medicine, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
- Department of Neurology, Klinikum Agatharied, 83734 Hausham, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
- Medical Valley-Digital Health Application Center GmbH, 96047 Bamberg, Germany
- Fraunhofer Institute for Integrated Circuits, 91058 Erlangen, Germany
| | - Tobias Warnecke
- Department of Neurology, University of Muenster, 48149 Münster, Germany;
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44801 Bochum, Germany;
| | | | - Ingmar Wellach
- Office for Neurology and Psychiatry Hamburg Walddörfer, Wiesenkamp 22 c, 22359 Hamburg, Germany;
- Department of Neurology, Ev. Amalie, Sieveking Hospital, 22359 Hamburg, Germany
| | - Martin Wolz
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany;
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Neustädter ME, Adorjan K, Kistner N, Glaser M, Hummel I, von Saldern S, Palm U, Dehning S, Pogarell O, Karch S. [Successful treatment in the day clinic of the Clinic for Psychiatry and Psychotherapy of LMU Munich. Experienced changes from the patients' perspective]. MMW Fortschr Med 2018; 160:6-10. [PMID: 30367439 DOI: 10.1007/s15006-018-1050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In the day clinic of the Department of Psychiatry and Psychotherapy of the LMU Munich, a multimodal therapy concept is offered. The goals of treatment are, in addition to the reduction of symptoms, an expansion of everyday life skills and the professional and social reintegration of patients. METHOD The effectiveness of the therapeutic work was evaluated over a period of just under 3 years. Both the therapist and the patients themselves assessed the success of the treatment. RESULTS Subjective measures: The affective (BDI: 17.45 at the beginning vs. 9.38 at the end) and the anxiety symptoms (STAI: 49.51 at the beginning vs. 42.11 at the end) decreased. The quality of life (WHOQOL-Bref: 40.96 at the beginning vs. 62.50 at the end) increased. Performance (COPM: 3.81 at start vs. 6.91 at end) and satisfaction with it (COPM: 3.48 at start vs. 7.08 at end) improved. Physician's judgment: The global assessment of functioning (GAF: start of therapy 54.91 vs. end of therapy 68.14) and the clinical global impression (CGI: start of therapy 4.48 vs. treatment end 3.03) showed an improvement. All results were significant. CONCLUSION The day clinic's treatment concept seems to work comprehensively, both in patients with depressive disorder and in patients with schizophrenic disease.
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Adorjan K, Thoma C, Tchipeva E, Janjic K, Leidger A, Hoch E, Koller G, Falkai P, Pogarell O, Karch S. [An effective treatment concept for patients with substance use disorders]. MMW Fortschr Med 2017; 159:1-5. [PMID: 29557094 DOI: 10.1007/s15006-017-0079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/12/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND At the Department of Psychiatry and Psychotherapy of the University of Munich a "day clinic for substance use disorders" was opened in 2014. A multimodal treatment concept for patients with addictions was developed. Employees of the clinic performed a first scientific study to assess the effects of treatment approaches on the course of the disease. METHOD Data were collected over two years to evaluate the treatment concept. I. a., the severity of depressive symptoms, anxiety symptoms, craving and several aspects of the subjective quality of life were documented. In addition, participants were examined about their contentment with the day-clinic treatment. RESULTS Symptoms of depression, anxiety and craving were significantly reduced during the day-clinic treatment. The subjective quality of life increased almost in all areas. CONCLUSION In order to stabilize patients with addictions, a multimodal treatment concept can be applied effectively.
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Affiliation(s)
- Kristina Adorjan
- Tagklinik für Suchterkrankungen Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Nußbaumstr. 7, 80336, München, Deutschland.
| | - Carmen Thoma
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Elitza Tchipeva
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Klaudia Janjic
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Anne Leidger
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Eva Hoch
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Gabriele Koller
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Peter Falkai
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Oliver Pogarell
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Susanne Karch
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
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Holas P, Suszek H, Szaniawska M, Kokoszka A. Group Cognitive-Behavioral Therapy for Anxiety Disorders With Personality Disorders in Day Clinic Setting. Perspect Psychiatr Care 2016; 52:186-93. [PMID: 25817744 DOI: 10.1111/ppc.12115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 01/26/2015] [Accepted: 02/19/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Short-term group cognitive-behavioral therapy (GCBT) with weekly homogeneous group sessions for treating specific anxiety disorders is relatively well developed and recognized. However, 12 weeks of intensive daily therapy for mixed anxiety and personality disorders is not. The current article aims to fill this gap by presenting the method of intensive transdiagnostic GCBT for anxiety disorders with comorbid personality disorders in a day hospital setting. Preliminary studies showed that participants exhibited significant improvement during this type of treatment. CONCLUSIONS This article reviews the advantages of group therapy that is transdiagnostic over the homogeneous group and individual therapy formats. PRACTICE IMPLICATIONS The detailed description of the current therapeutical program may facilitate the development of similar programs in day clinic settings.
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Affiliation(s)
- Pawel Holas
- Psychology Department, University of Warsaw, Warsaw, Poland
| | - Hubert Suszek
- Psychology Department, University of Warsaw, Warsaw, Poland
| | - Monika Szaniawska
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
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Zeeck A, von Wietersheim J, Hartmann A, Einsele S, Weiss H, Sammet I, Gaus E, Semm E, Harms D, Eisenberg A, Rahm R, Küchenhoff J. Inpatient or day clinic treatment? Results of a multi-site-study. Psychosoc Med 2009; 6:Doc03. [PMID: 19911075 PMCID: PMC2775197 DOI: 10.3205/psm000059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: This naturalistic study aimed to identify criteria which are of relevance for making a decision as to whether inpatient or day hospital treatment is indicated. Methods: In 567 patients who were consecutively admitted to 10 departments of psychosomatic medicine (day hospital or inpatient setting) in Germany, symptom severity at admission and discharge was measured (Symptom-Check-List-90-R, Global Assessment of Functioning). Before admission, clinicians rated aspects that might be important for differential indication (Rating Scale of Indication Criteria). A regression analysis was conducted to reveal relationships between outcome in each setting and possible predictors (criteria of relevance). Results: At admission inpatients and day clinic patients already showed some differences referring to aspects clinicians used to select patients for each setting. Good outcome in day hospital patients was associated with a high motivation and higher burdens at home, whereas reduced drive and loss of interest was correlated with a less favourable course. Inpatients did less well if their symptoms were triggered by situations at home and if they showed a high potential for regression. Conclusion: Results give first hints for criteria which are relevant for making a decision between inpatient and day hospital treatment in psychosomatic medicine.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Germany
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