Zeitschrift für Medizinische Psychologie

Medical Psychology within the new legislation on licensure requirements for physicians – an empirical ananlysis of the implementation process

With a new legislation on licensure requirements for physicians (ÄAppO, 2002) coming into force, German Universities have been given the task of restructuring their preclinical and clinical programs of medical studies. Since these new licensure requirements for physicians were announced, a discussion has been going on about the involved chances and risks for the psycho-social curriculum.

In a survey on behalf of the DGMP (Deutsche Gesellschaft für Medizinische Psychologie; German Society for Medical Psychology) the directors of institutes for medical psychology at German universities were asked about their experience with the implementation of the new ÄAppO.

The institutes report on advantages as well as disadvantages. Advantages are a) the improved integration of medical psychology and other psycho-social and medical subjects and b) the increased impact of mediccal psychology in the course of the study. Disadvantages are particularly a) the increased stress students and lecturers are subjected to due to the new comprehensive curriculum and b) the omission of the oral examination in medical psychology in the first part of the examination.

Implementing the new ÄAppO the institutes for medical psychology initiated various changes in their medical curriculum, nevertheless its full potential seems to be not fully tapped yet.

Personal resources and coping of patients with inflammatory bowel diseases (IBD)

The study examines the relationship between personal resources and coping strategies and quality of life in patients with inflammatory bowel disease (IBD). We assume that active, problem-oriented coping and passive, depressive coping as well as optimism and self-efficacy may be mediators with regard to quality of life. Activity of inflammation, on the other hand, may be a moderating variable. N = 129 patients with a diagnosis of IBD and an age between 18 and 75 years participated in two subsequent assessments at a mean interval of 26 weeks. The following instruments were used at the first assessment: FKS-LIS for the assessment of coping styles (Muthny, 1989) and SWOP for the assessment of optimism and self-efficacy (Scholler et al., 1999). At the second assessment, quality of life was assessed by the following instruments: LZI (Muthny, 1991), German SIBDQ (Rose et al., 2000), and ACSA (Bernheim & Buyse, 1983). The results are not in accordance with our assumptions. Neither active, problem-oriented coping nor optimism or self-efficacy predict future quality of life. Passive coping, however, interferes negatively with the quality of life outcome and is regarded to be a mediating variable. Moderators cannot be found. The results underscore the necessity to further examine the impact of coping on quality of life in subsequent studies.

In this study the musical-component of a new school-based nutrition preventive approach for children of the Federal Center for Health Education, named “Kinderliedertour Apfelklops & Co” is presented and data on acceptability of the program and behaviour change are reported. 704 primary school children were administered the acceptability questionnaire, 227 children took part in the behavioural observation. Thereby to evaluate the behaviour change a pretest-posttest, control group design was utilized with 137 children in the experimental group and 90 children in the control group. Results showed high levels of acceptability: 97.8% of the chil-dren reported they liked the program much or very much. Behaviour changes during school break for the experimental group were not observed: when asked to choose a drink among healthy as well as unhealthy ones, for children in the experimental group, there was no dif-ference over time in the choice of a healthy drink. However, children in the control group showed a significant decrease in the choice of a healthy drink at post-test relative to pre-test.

FABAG–Questionnaire for breathing complaints of allergic origin. Construction and initial results on reliability and validitiy

Objectives: The FABAG questionnaire was developed to identify people with allergic diseases when allergy testing is not possible or inappropriate.

Methods: Item selection and scale construction were performed using a questionnaire for taking medical history of allergic diseases in medical practice. Internal consistencies, retest reliability, discriminant analyses and ROC-analyses were computed.

Results: The first version of the questionnaire contained 103 items. These were reduced to 49 items. They constitute four complaint scales (rhinoconjunctivitis, skin symptoms, asthma, continuous colds) and three scales of trigger factors (seasonal type, perennial type, animal type). In addition allergy-related illness behavior constitutes a relevant psychological dimension. Internal consistencies for the main scales range from satisfying to very good, retest reliabilities from good to very good. The test seperates persons with positive versus negative skin testing for pollen high specifically.

Conclusion: The FABAG seems to be a useful instrument to identify subjects with allergic seasonal rhinoconjunctivitis.

Investigation and improvement of pathological voices

An understandable and loud voice is the precondition to avoid social retreat of patients with operations of the larynx. In this projet we followed three aims: Firstly, we asked patients for communication problems in ADLs, then we analyzed the voices of patients with operation or resection of the larynx. In addition, we tried to improve the understandability of these pathological voies with technical devices. For this purpose, we recorded and analyzed standardized vocal tasks of 43 patients (Elektrolarynx, ructus and pharyngeal fistula). The best voice after resection of the larynx had the patients with fistula. Objective investigations showed considerable deficits of average number of syllables per minute, pressure of sound and maximal duration of sounds. Typical records were modulated with a computer program to increase understandability. Then 36 rater judged the records of the original voices and the modulated versions. We were able to show an improvement of the understandability of these voices following the computer-based changes in many patients.

Migraine – Pathophysiological aspects and non-pharmacological treatment

The pathophysiology of migraine is complex. According to a diathesis-stress-model, stressful stimuli trigger a migraine attack on the background of a primary neurological function deficite (diathesis). Although the discurbances are of a neurological nature, recommendations for the treatment of migraine include both pharmacological and non-pharmacological approaches. Non-pharmacological approaches enable the patient to a higher responsibility andsflf-efficacy in coping with migraine. Therefore, the active involvement of the patient in the treatment is obligatory in all psychological pain therapy methods. The focus of non-pharmacological therapy is on emotional, cognitive, behavioural and social factors of migraine, with the aim to modify unfavourable habits and migraine attack-inducing factors. Among non-pharmacological methods, counselling, relaxation training, biofeedback and cognitive-behavioural treatments are employed. The long-term effects of these methods are comparable to those of prophylactic pharmacological treatment. Combination of pharmacological and non-pharmacological treatment leads to even higher efficacy and is often indicated. In case of headache in children, behavioural therapy should be the method of first choice. In this paper, empirically proven methods of psychological pain therapy in migraine are presented.