Biomedical subjects

R Vauth

Publications and source records attributed to R Vauth.

11 recordsLinked to original sources

PubMed2006

[Evidence basis of psychotherapy for schizophrenia patients in Germany].

BACKGROUND: Little is known about the degree of implementation of evidence-based psychotherapy in routine care of people with schizophrenia in Germany. METHOD: First, results of studies on the efficacy of psychotherapy in the treatment of schizophrenia are summarised. Second, the degree of implementation of psychotherapeutic practices in the routine care of schizophrenics is assessed through a systematic literature search and analyses of several data sets. RESULTS: There is substantial evidence for the efficacy of cognitive-behavioural interventions in the treatment of schizophrenia. The paucity of data on the degree of implementation suggests a wide gap between evidence and practice. CONCLUSIONS: Barriers to implementation are outlined and discussed. There is a need for more studies on epidemiological and long-term effectiveness of health care.

Clinical Trials as Topic↗

PubMed2005

[Behavioral concepts for the etiology of schizophrenia].

Schizophrenic disorders are a relatively common and severe psychiatric disorder. Extensive research efforts during the last two decades could show that the course and outcome of the disorder will be determined by a number of biological, psychological and social factors. The vulnerability-stress-coping-competence-model as a tentative heuristic framework integrates the different factors which contribute to the understanding of the disorder. In this model psychological factors play an important role. Some of these factors are subject of this paper: expressed emotions and the cognitive understanding and treatment of delusions and hallucinations.

Behavior↗

PubMed2004

[Outcome of interactive training in detection and management skills for schizophrenic outpatient treatment by general practitioners].

THEORETICAL BACKGROUND: Of all outpatients with a diagnosis of schizophrenia, 30-40% refuse a psychiatrist's care. For this group of patients the general practitioner holds a key position for such different tasks as detection of prodromal schizophrenia or early warning signs of relapse and identification of risk variables for deteriorating outcome, gatekeeping (referral to specialists or other services), integration, and counseling of key relatives. Fifty percent of GPs are interested in disease-specific medical education programs. STUDY DESIGN AND METHODS: A control trial examined the changes that participating GPs intended to make in three main topics of the curriculum: (1) changing attitudes (pessimistic outcome expectation, low self-esteem), (2) enhancement of detection skills (prodromal schizophrenia, early warning signs of relapse, and risk factors for poor social and vocational integration), and (3) enhancement of management skills (dosing schemes, motivational interviewing). RESULTS: In the assessment 2 weeks after the training session, we found significant changes in favor of the trained group in detection and management skills and also improved self-confidence of GPs. CONCLUSIONS: Problem-oriented and case-based learning strategies should be preferred to lectures in training programs for psychiatric skills in primary care.

Adult↗

PubMed2001

[Prescribing of sildenafil by national insurance program physicians. What basic sexual medicine qualification is required?].

The role of sildenafil in the treatment of erectile dysfunction is discussed. Especially in primary care there is a necessity to weigh the individual cost-benefit-ratio. Functional analysis of erectile dysfunction, exclusion of psychiatric and organic comorbidity, identification of sexual deviance and couple counseling about the advantages and disadvantages of sildenafil prescription are the core prerequisites of sildenafil application in primary care. The counseling model of PLIS-SIT is proposed as a guideline for counseling process. Current approaches of education for general practitioners are reviewed and the integration in a recently developed training for management of psychiatry and psychosomatic illness in general medical settings is proposed. Finally open questions for research and quality management are discussed.

Cost-Benefit Analysis↗

PubMed2001

[Differentiated short- and long-term effects of a "Training of Emotional Intelligence" and of the "Integrated Psychologic Therapy Program" for schizophrenic patients?].

Social cognition was shown as a rate limiting factor for both psychosocial outcome and response to psychosocial intervention in schizophrenia. In a randomized controlled trial a new cognitive-behavioral group treatment for schizophrenic inpatients (the "Training of Emotional Intelligence", TEI) was tested against the well evaluated "Integrated Psychological Therapy Program" (IPT) of H. Brenner. Within the framework of P. Salovey's work the Training of Emotional Intelligence focussed on three domains of deficits in schizophrenia: emotional perception, emotional understanding and emotional management. In the randomized controlled trial with 41 DSM-IV schizophrenic inpatients no differences were found in problem-solving and negative symptoms, both post treatment and in the 12 months-follow up. Additionally there was a better outcome in affect decoding capacity post treatment, and a progess in regulation of negative affects in the follow up. Emotional role taking behavior and social anxiety returned to baseline level, perhaps by reasons of no "booster sessions" in the follow up. Unfortunately in contrast to our hypotheses we failed to show treatment-specific effects, which may be due to an underpowered statistical testing. There was only one exception of this: While the Integrated Psychological Therapy Program showed a greater reduction of global psychopathology after treatment, the Training of Emotional Intelligence reduced psychopathology in the follow up more strongly. Possible reasons for these results are discussed.

Adult↗

PubMed2000

[Cognitive remediation. A new chance in rehabilitation of schizophrenic disorders?].

A critical review of current approaches and principles of cognitive remediation strategies in rehabilitation of schizophrenia is given. Selection of cognitive functions targeted in compensatory training programs could be based on results of neuropsychological predictor research on social and vocational functioning in community and neuropsychological rate limiting factors in rehabilitation. Methodological flaws in data base, missing of task analysis of more complex skills like social perception, social skills and interpersonal problem solving and the lack of evaluation of training generalization on work performance are discussed. Finally the cognitive remediation program developed in the Department of General Psychiatry and Psychotherapy/University of Freiburg, Germany is proposed. The components focused on training in attention, memory, and executive function (decision making, planning). Compensatory strategy building, and computer-mediated automatization are integrated in a group setting.

Cognition Disorders↗

PubMed1999

[Management of mental health and primary care. Development and evaluation of a training program based on the PLISSIT approach].

Deficits in current approaches of psychosomatic and psychiatric education for general practitioners are reviewed. A skill-based training was developed in line with the four step counseling approach of the "PLISSIT" approach: The GP helps in first step ("permission") the patient to accept his problem and assesses informations about causing and maintaining factors of his symptomatology. In the second step he should provide information about the disorder and reverse misunderstanding and passivity (Limited Information). The GP's should develop preliminary strategies for change in the third step ("coping strategies", "symptom management", "special suggestions") and preparate the intensive phase of therapy as the last step. First results of the evaluation of the training program are presented demonstrate the effectiveness and acceptance of the education program.

Disease Management↗

PubMed1999

[Pharmacologic and cognitive therapy treatment strategies in in persistent negative schizophrenic symptoms].

Negative symptoms are a cofeature of schizophrenia which constitute a severe burden on relatives as well as on the patient himself. Novel (atypical) antipsychotic drugs unlike conventional antipsychotics cause substantial progress in the treatment of negative symptoms. Methodological flaws in recent studies which evaluate the effectiveness of neuroleptics in negative symptoms are being discussed critically. Especially the needs for differentiation of primary and secondary negative symptoms are underlined. Cognitive behavioural rehabilitation strategies are also reviewed. A newly developed cognitive behavioural approach in the treatment of negative symptoms developed by the "Research Group for Rehabilitation in Schizophrenia" of the Department of Psychiatry at the Freiburg University is proposed. A framework is discussed in which neuroleptic treatment optimalization and enhancement of coping strategies by psychosocial approaches are integrated. The need for integrating the patient in rehabilitation and treatment planning is underlined. Despite the limitations of methodology of most studies the findings of research reviewed here could be able to stimulate the optimalization of rehabilitation with these patients. It is necessary to ensure that all patients--especially those with high risk for deteriorating outcome--receive optimal treatment at the earliest possible stage in the course of their schizophrenic disorder. Progress in early intervention strategies [42] are therefore of outstanding interest. Main barriers to effective treatment have to be considered: noncompliance (and side-effects) of medication, repeated relapse, "treatment resistance", negative symptoms, and neurocognitive deficits. These factors indicate the need to favour integrated treatment approaches in which drugs and psychosocial strategies can be combined in a manner that maximizes the potential synergism.

Antipsychotic Agents↗

PubMed1996

[Goals, content and evaluation of training seminars for quality circle moderators].

In this paper, our experience with training courses for quality circle moderators is reported. Basic principles of the peer review method in general and the specific model of the topic-oriented quality circle approach in the ambulatory care in Sudbaden is described. Peer review in quality circle groups demands specific participants' skills. Thus, training courses for quality circle leaders have been set up to prepare moderators for their task. Attention is given to the goals and contents of training courses for physicians. Key elements are the supervisory role of the moderator and specific tasks in handling the group dicussions. Evaluation questionnaires after the courses showed that the participants (n = 41) judged the programme very positively.

Curriculum↗

PubMed1996

[Organization of practice oriented knowledge structures by the "cognitive apprenticeship" method].

The introduction of the new German specialist for psychiatry and psychotherapy increased the requirement for more integrated and flexible clinical training programs for residents. The integration of this multitude of more sophisticated diagnostic and therapeutic strategies in an individualized treatment plan for each patient requires new teaching strategies. The instructional method "Cognitive Apprenticeship" in acquisition of treatment planning-competence is discussed within a curriculum framework.

Curriculum↗

PubMed1993

[Possibilities for psychological intervention in persistent delusions and persistent acoustic hallucinations in schizophrenic patients].

In practice the therapy of treatment resistant psychotic symptomatology (delusions and hallucinations) is a difficult and up to now unsolved problem. This overview presents and discusses behaviour therapy oriented studies (in the main part single case studies). The majority of studies show that it is in principle possible to influence this symptomatology. Because of methodological limitations of many studies finally some proposals for future research are discussed.

Adaptation, Psychological↗