Differenzielle Indikationsstellung stationärer und tagesklinischer Psychotherapie: die DINSTAP-Studie

Abstract

Aim of the "DINSTAP"-study is to identify criteria that are of importance for a decision between inpatient or day clinic treatment in patients that are usually admitted to psychosomatic clinics in Germany. 299 inpatient and 268 day clinic treatment episodes from 10 clinics were included in the study. Next to basic data and diagnosis, severity of symptoms and impairment were evaluated (pre, post). A questionnaire was developed which includes aspects that are relevant for differential indication according to clinical experts. This questionnaire was filled out before admission. First results show that patients in both treatment settings were comparable concerning impairment at intake. Inpatients showed better improvement (SCL-90-R, GAF) over the course of treatment. Aspects like the necessity of relief from everyday tasks or a daily "training situation" at home allowed a prediction of therapist's decision for inpatient or day clinic treatment. Further detailed analyses are planned to answer the question of differential indication more comprehensively.

The INDDEP study: inpatient and day hospital treatment for depression – symptom course and predictors of change

“…These comprise three psychosomatic departments at university hospitals and four clinics outside the university context. All departments or clinics provide a treatment program that is typical for clinics of psychosomatic medicine in Germany (see [5,21]). Participating centers are the Department of Psychosomatic Medicine and Psychotherapy at the University Clinic of Freiburg, the Clinic of Psychosomatic Medicine and Psychotherapy at the University of Ulm, the Department of Psychosomatic Medicine and Psychotherapy at the University Clinic of Mainz, the Clinic for Psychosomatic Medicine and Psychotherapy at the Robert-Bosch-Krankenhaus Stuttgart, the Thure-von Uexküll-Klinik Freiburg, the Clinic for Psychosomatic Medicine and Psychotherapy at the Bürgerhospital in Stuttgart and the Rhein-Klinik, Bad Honnef.…”

“…These include individual and group psychotherapy, art and body therapy, relaxation therapy, family sessions and support of a social worker if needed, psychopharmacology, educational elements, physician rounds and medical care (see [5]). Treatment duration usually comprises between 4 and 12 weeks [5]. …”

“…In comparison to outpatient treatment, hospital programs have the advantage of using a multimodal approach, combining daily structure with individual, group and additional treatment components [5]. Day hospital programs for acute psychosomatic care are comparable to inpatient programs with the difference that patients return home at evenings and weekends.…”

“…Comparing means of large samples might cover differences between subgroups, which can be better treated in one or the other setting. In a pilot study, we tried to identify predictors of differential outcome of inpatient and day hospital treatment and found a higher motivation for psychotherapy and higher burdens at home to be associated with a good outcome after day hospital treatment, whereas strong wishes to give up responsibility for oneself were associated with an unfavourable course of inpatient treatment [5,21]. Strong wishes to give up responsibility might be associated with “anaclitic” features according to S. Blatt et al [18], but this has to be shown empirically.…”

Dokumentation der differentiellen Behandlungsindikation bei depressiven Störungen: Entwicklung und Machbarkeitsprüfung des STEP-D (englisch: Setting Guide for Patients with Depression)

“…Dies ist unter anderem sinnvoll, weil stationäre, verglichen mit ambulanten, Behandlungen eine bis zu 10-fach schnel lere Symptomreduktion bewirken können [5]. Tagesklinische und stationäre Behandlungen sind in ihrer Behandlungsintensität ähnlich [6]. Die Wahl zwischen beiden Settings richtet sich daher neben dem Schweregrad der Symptomatik auch nach weiteren Faktoren.…”