Biomedical subjects
Gereon Heuft
Publications and source records attributed to Gereon Heuft.
[Psychosomatic and psychotherapeutic medicine goes DRG -Procedure-catalog OPS-301 2.1 as a first step].
To demonstrate the repercussions for Psychosomatic and Psychotherapeutic Medicine of the politically motivated decision to introduce case mix funding for inpatient treatment in Germany. Description of the development of an appropriate code list of procedures for Psychosomatic and Psychotherapeutic Medicine within the DRG-System. The code list OPS-301 which was valid in 2001 had no appropriate procedures for Psychosomatic and Psychotherapeutic Medicine. The scientific societies therefore had to develop possibilities for coding psychosomatic-psychotherapeutic procedures in the new OPS-301 2.1 which is valid since January 2002. This was achieved through the formulation of so-called complex codes, which are presented together with first coding tips. There are further tasks with risks and potential benefits which have to be accomplished after establishing these complex codes.
[Psychic impairment in psychosomatic and psychiatric quality assessment: global assessment of functioning scale (GAF) vs. impairment score (IS)].
OBJECTIVES: The Global Assessment of Functioning Scale (GAF) and the Impairment-Score (IS) are important instruments for Quality Assessment. There are only few studies examining the quality of statistical power of the GAF-Scale indicating problems in construct validity and no larger studies for the IS. METHODS: For a sample of 263 patients the Psy-BaDo and an OPD-Rating were completed. RESULTS: Though the distribution of both scales show large range, the proportion of explained variance is 58 %. This proportion can be increased to 68 % for the IS by including the OPD-Ratings. The GAF-Scale in contrast is not associated with the OPD-Ratings. CONCLUSIONS: The results indicate, that the combination of both scales is necessary to represent the whole variance of psychic impairment (ICD-10 Chapter F & Z). In addition the valid rating of both scales is very difficult for patients with somatic disorders and somato-psychic problems.
[On the effects of psychoanalytic oriented psychotherapy - an inpatient multicenter study]
Whereas the efficacy of inpatient treatment in socalled psychosomatic rehabilitation clinics in Germany has been well researched and documented, studies involving large samples on the efficacy of inpatient treatment in acute hospitals are lacking. A multicentered retrospective study involving clinics for psychotherapy at three separate universities was conducted on a sample of n=495. The patients were treated on an inpatient basis between April 1990 and July 1998 in one of the clinics. The predominant approach to treatment of these clinics was psychodynamic. Other approaches such as behavioral therapy are integrated. In addition to sociodemographic variables clinical data (SCL-90-R, IIP, BSS, ICD-Diagnosis) at admission and discharge were collected. A follow-up study was not conducted. With an average effect size of 0.84 in terms of clinical scales the results demonstrate good efficacy of inpatient treatment. Effect sizes were high on the depression, obsessive-compulsive and anxiety scale of the SCL-90-R, and were low on the phobia subscale. By self report 55% of all patients indicated they had markedly improved, 22% indicated no change and 6% stated they were worse. 17% of all patients were below the chosen cut-off point of the GSI. Patients with a low level of education took benefit as well from the offered therapy. There was no clear relationship between effect size and length of hospital stay. This may be due to the particular setting of a university clinic.
Ageing styles: subjective well-being and somatic complaints in inpatients aged >/=60 years.
BACKGROUND: Recent gerontological research shows a high variability in the elderly population. The aim of the present study is to investigate by means of cluster analysis, as to whether different 'ageing styles' can be identified in a sample of cognitively not impaired older persons, and to assess discrepancies between self-rated and expert-rated psychological and physical health. METHOD: 243 patients aged 60 years and older in a general hospital were investigated using a clinical psychiatric interview, expert ratings, and self-report scales after extensive internal medical diagnostic evaluation. RESULTS: Five clusters, representing significantly different 'ageing styles' with regard to subjective well-being and subjective physical complaints, could be identified. Two clusters, which together constituted 57% of the sample, represented quite positive and desirable ageing styles. In two clusters (altogether 23% of the sample), there was a discrepancy between medical findings and subjective physical complaints. CONCLUSIONS: These findings support the notion of high variability in the elderly and the existence of subgroups, which show a discrepancy between subjective assessment of well-being and expert assessment of psychological and physical health and impairment. The recording of subjectively perceived physical complaints should, therefore, be part of the evaluation of older peoples' subjective well-being.
Subjective body complaints as an indicator of somatization in elderly patients.
The authors examined the correlation of subjective body complaints (measured by the Giessen Subjective Complaints List) with sociodemographic data, objective health measures, measures of subjective well-being, and clinicians' ratings of somatization and psychological impairment in 251 cognitively unimpaired general hospital inpatients aged >/=60 years. The level of subjective body complaints correlated most highly with self-assessed life satisfaction and age-related changes and with the clinicians' rating of somatization. The results suggest that the level of subjective body complaints is determined by subjective well-being rather than by objective health measures, and thus subjective body complaints may be an indicator of somatization in elderly inpatients.