Anxiety disorders and workplace-related anxieties

BACKGROUND: Workplace-related anxieties are often connected with sick leave. There are no established instruments which allow to assess this phenomenologically heterogeneous group of disorders. METHOD: One hundred and thirty-two psychosomatic inpatients were interviewed with a standardized diagnostic interview in respect to mental illnesses, especially primary anxiety disorders, and in addition in respect to different work-related anxiety disorders. RESULTS: Seventy-one percent of women and 54% of men complained about work-related anxiety. 20.5% of participants are suffering from work-related panic, 58% from work-related phobia, 34.1% from work-related social phobia, 39.4% from work-related generalized anxiety, and 1.5% from work-related PTSD. There is a moderate relation between mental disorders or primary anxiety disorders and work-related anxiety. Fourteen percent of the participants did only suffer from workplace-related anxiety and did not report any other anxiety disorder outside the workplace situation. CONCLUSION: There are various types of workplace-related anxieties. They are partly independent clinical phenomena deserving special diagnostic and therapeutic attention.     

Socio-medical aspects of mental disorders : Definition, epidemiology, context and assessment of capacity

Social medicine is an interdisciplinary field of medicine which analyses and describes the interactions between illness, individual, society, and organisational structures of the health care system, including prevention, treatment and rehabilitation. Part of social medicine is epidemiology, including analytic epidemiology. The goal is to monitor the prevalence and spectrum of illnesses in the general population or subpopulations and to study possible risks of illness. The question is which environmental or contextual factors influence the prevalence and course of illnesses. Another area of social medicine is to evaluate patients and decide who needs social support. Important topics are inability to work, need for early retirement and pension, or disability. In this context it is important to make a distinction between functions, capacities, context and participation. There is a second paper on social medicine which covers modes of care and treatment in social medicine.     

Is it a Case of “Work-Anxiety” When Patients Report Bad Workplace Characteristics and Low Work Ability?

Aims Work-anxiety may produce overly negative views of the workplace that impair provider efforts to assess work ability from patient self-report. This study explores the empirical relationships between patient-reported workplace characteristics, work-anxiety, and subjective and objective work ability measures. Methods 125 patients in medical rehabilitation before vocational reintegration were interviewed concerning their vocational situation, and filled in a questionnaire on work-anxiety, subjective mental work ability and perceived workplace characteristics. Treating physicians gave independent socio-medical judgments concerning the patients’ work ability and impairment, and need for supportive means for vocational reintegration. Results Patients with high work-anxiety reported more negative workplace characteristics. Low judgments of work ability were correlated with problematic workplace characteristics. When controlled for work-anxiety, subjective work ability remained related only with social workplace characteristics and with work achievement demands, but independent from situational or task characteristics. Sick leave duration and physicians’ judgment of work ability were not significantly related to patient-reported workplace characteristics. Conclusions In socio-medical work ability assessments, patients with high work-anxiety may over-report negative workplace characteristics that can confound provider estimates of work ability. Assessing work-anxiety may be important to assess readiness for returning to work and initiating work-directed treatments.     

Induction of false beliefs and false memories in laboratory studies—A systematic review

Psychological interventions often use guided discovery and other techniques for diagnostic exploration and intervention planning. This way, memories may arise in the person, which may be true or false. False memories of earlier events can be harmful and result in real suffering, similar to actual traumatic memories. Based on cognitive psychological and psycho-traumatological findings, there is pronounced dissent in the academic disciplines regarding the conceptualization, relevance and research of false memories. This review contributes to the basic question of how often false beliefs and false memories may be induced within the frame of different interactional techniques. A systematic review has been conducted of 59 articles from (quasi-)experimental studies and two qualitative sources from 30 data bases. Three main methods of memory induction provide the basis for reporting: imagination inflation, false feedback, and memory implantation. Due to the conceptual and methodological diversity of the studies, the results appear to be heterogeneous. Free and guided imagery, as well as suggestive statements, could induce false beliefs or false memories in, on average, 20%–50% of the participants who underwent experimental manipulation concerning false past events. A false belief induction may occur after dream interpretation or hypnosis in more than 50% of participants. Personalized suggestion is more effective in inducing memory than the general plausibility of the suggested events. Further research questions are which therapeutic actions seem appropriate in cases of harmful false memories. This depends not only on whether there are veridical elements in the false memory but also on the quality and meaning of the memory for the person's life and ability to cope with burdens.     

Arbeitsplatzbezogene Ängste und Arbeitsplatzphobie

Work is an important aspect of life. Problems at the workplace must therefore have negative consequences on the mental status and mental problems will interfere with the working place. The relation between anxiety and the workplace is especially important because the workplace causes anxiety due to its very nature. A common final pathway of mental disorders in general, and work related anxieties in particular, are workplace phobias, with panic when approaching or even thinking of the workplace. This is a serious complication with negative consequences for the further course of illness. It makes special therapeutic intervention necessary. This paper describes the phenomenon of workplace related anxieties and phobia and provides a conceptual framework for their understanding.     

The effect of multiple cryopreservation procedures and blastomere biopsy on the in-vitro development of mouse embryos

Preimplantation genetic diagnosis is currently used in clinical practice. In experienced hands the biopsy procedure alone does not affect the further in-vitro and in-vivo developmental potential of animal and human embryos. No data exist on the combination of cryopreservation of embryos at the pronuclear and/or 8-cell stage and/or biopsy at the 8-cell stage. Pronuclear stages of mouse F1 hybrids (C57Bl/jxCBA) were harvested and divided into several experimental groups. The developmental rates of zygotes, which were neither biopsied nor cryopreserved were used as data control. Others were only cryopreserved at the pronuclear stage (C-PN), or at the cleavage stage (C-CS), or both. Each of these groups was also combined with or without a biopsy. Only the hatched blastocyst rate (HBR), but not the 'simple' blastocyst rate, showed significant differences between groups. Neither C-PN (HBR = 60.42%), nor C-CS (63.16%), nor a combination of both (59.46%) had an impact on the hatched blastocyst rate when compared with that of the control group (67.46%). The biopsy procedure (55.93%) also proved not to be harmful for the embryos. The embryos, which were C-PN and C-CS, and subsequently biopsied, showed a significantly lower hatched blastocyst rate (39.62%) than that of the control, C-PN, C-CS, and C-PN/C-CS groups (P < 0.05). The combination of C-PN and cleavage-stage biopsy also lead to a lower hatched blastocyst rate (42.22%), compared with that of the control group (P < 0.05). It was concluded that couples must be advised that an effect on embryos which have undergone a combined cryopreservation and micromanipulation procedure cannot be ruled out. However, cryopreservation at the pronuclear or at the 8-cell stage alone, or in combination with a biopsy procedure, does not influence the further development of the embryo.      

Negative work perception not changed in a short work-anxiety-coping group therapy intervention

Background: Work anxiety is often associated with long-term sick leave and requires early intervention. Work anxieties are associated with negative work perception. Therefore, one aim in early intervention is a cognitive reframing of dysfunctional perceptions of workplace characteristics.

Methods: A psychotherapeutic specialist conducted two group programs of four sessions each. One hundred twenty-three rehabilitation in-patients with work anxieties were randomly assigned either to a work anxiety-coping group or to a recreational group. The Short Questionnaire for Work Analysis (KFZA) was administered before and after the group treatment to measure perceptions of working conditions.

Results: Participants from the work anxiety-coping group did not see their work in a significantly more positive light at the end of the intervention compared to participants from the recreational group.

Conclusions: A short work anxiety-coping group did not initiate a consistent positive re-appraisal of work. Employers and occupational physicians should not expect positive changes of work perception when an employee returns from short medical rehabilitation including work-directed treatment. Additional support from the workplace must be considered, e.g. employer–physician–employee conversation preceding return to work, or (temporary) work adjustment.     

Sozialmedizinische Aspekte bei psychischen Erkrankungen

In the first article social medicine was defined. In this second article the health care system and special socio-medical treatments for the individual are described. The role of social medicine is to describe and optimize the health care system. The legal basis for the structure of the health care system is the Social Law. The individual encounter between therapists and patients is also regulated by law. This includes a contract of personal service. Liability of therapists is therefore restricted to correct treatment, which must be documented, and not depending on outcome. Therapists must cooperate with each other. There are special socio-medical treatments for individuals. This includes sickness certificates, enforced treatment, guardianship, support by counselling services, socio-medical support by physicians and psychotherapists in private practice, care and assessment in rehabilitation centres, and measures for reintegration into working life.