Attachment--and loss.

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

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Introduction To Robust Estimation And Hypothesis Testing

Unraveling the Mystery of Health

Context The place of long-term psychodynamic psychotherapy (LTPP) within psychiatry is controversial. Convincing outcome research for LTPP has been lacking. Objective To examine the effects of LTPP, especially in complex mental disorders, ie, patients with personality disorders, chronic mental disorders, multiple mental disorders, and complex depressive and anxiety disorders (ie, associated with chronic course and/or multiple mental disorders), by performing a meta-analysis. Data Sources Studies of LTPP published between January 1, 1960, and May 31, 2008, were identified by a computerized search using MEDLINE, PsyclNFO, and Current Contents, supplemented by contact with experts in the field. Study Selection Only studies that used individual psychodynamic psychotherapy lasting for at least a year, or 50 sessions; had a prospective design; and reported reliable outcome measures were included. Randomized controlled trials (RCTs) and observational studies were considered. Twenty-three studies involving a total of 1053 patients were included (11 RCTs and 12 observational studies). Data Extraction Information on study characteristics and treatment outcome was extracted by 2 independent raters. Effect sizes were calculated for overall effectiveness, target problems, general psychiatric symptoms, personality functioning, and social functioning. To examine the stability of outcome, effect sizes were calculated separately for end-of-therapy and follow-up assessment. Results According to comparative analyses of controlled trials, LTPP showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy. With regard to overall effectiveness, a between-group effect size of1.8 (95% confidence interval [Cl], 0.7-3.4) indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96% of the patients in the comparison groups (P= .002). According to subgroup analyses, LTPP yielded significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78-1.98). Conclusions There is evidence that LTPP is an effective treatment for complex mental disorders. Further research should address the outcome of LTPP in specific mental disorders and should include cost-effectiveness analyses.

Effectiveness of Long-term Psychodynamic Psychotherapy : A Meta-analysis. Commentary

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Increased Safety Behavior and COVID-19-Related Fear in Adults with Cystic Fibrosis during the Pandemic

Somatoforme Störungoder neurologisches Syndrom? – Fall1/2011

The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa.

Durch die zunehmende Verbreitung der morbiden Adipositas (BMI >40 kg/m2) entstehen neue Herausforderungen fur Behandler und das Gesundheitssystem. Die Adipositaschirurgie hat sich bei der morbiden Adipositas in den vergangenen Jahren als erfolgreiche Therapie erwiesen, allerdings zeigen nicht alle Patienten im Langzeitverlauf eine Gewichtsstabilisierung. Die umfassende postoperative Nachsorge und Psychoedukation dieser Patientengruppe wird in der Praxis oftmals nicht strukturiert durchgefuhrt. In dieser Arbeit wird ein Uberblick uber die aktuelle Studienlage zur psychoedukativen Nachsorge gegeben. Auserdem werden unterschiedliche Arten von Interventionen vorgestellt und diskutiert. Es zeigt sich, dass es an Studien fehlt, die die Effektivitat von psychoedukativen Nachsorgeprogrammen in prospektiven und kontrollierten Designs untersuchen und nachweisen.

Selbsthilfe, Psychoedukation und Gruppenpsychotherapie bei Adipositaschirurgie

The six authors present five pillars promoting Psychosomatic Medicine (PM) in Germany, namely, (1) Family Medicine, (2) Regional Health Care, (3) Transregional Rehabilitation Medicine, (4) Medical Socialization, (5) PM at Medical Schools. The authors proceed from the consensus that health care adheres to both the bio-psycho-social concept and the concept of integrated care being based on relationship. This is officially implemented in the advanced education policy of psychosomatic primary care (PPC) which is mandatory for family physicians/GP’s and for gynecologists/obstetricians and increasingly accepted in medical practice altogether. PPC comprises 80 hours of advanced education through: 30 hours group work (Balint/interactional), 30 hours verbal intervention, 20 hours theory of PM. Emphasis is laid on experience of the self. The zeitgeist in present Germany allows for the experience of the self. Both the physician and the patient are seen as individuals who are asked what they expect of each other in the NOW (here). The NOW (here) is embedded in past, present, future. Seen from outside, the expectations are filtered differently, i.e., evaluated either according to ICD or to ICF. ICD is the official system of classifying disorders and diseases in outpatients as well as in (acute) hospital patient care. ICF, however, is the official system of rehabilitation medicine to classify not disorders or diseases but functions. The zeitgeist allows taking a closer look at the filters mentioned. The symptom having a truth-bearing function may be seen not as a (semi-)permeable membrane but as a living filter, a kind of organic skin. ICD and/or ICF may be seen as the living filters of the physicians and their coworkers.

Martin Teufel

Papers

Increased Safety Behavior and COVID-19-Related Fear in Adults with Cystic Fibrosis during the Pandemic

Somatoforme Störungoder neurologisches Syndrom? – Fall1/2011

The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa.

Selbsthilfe, Psychoedukation und Gruppenpsychotherapie bei Adipositaschirurgie

Psychosomatic Medicine in Germany