Vorlesungen zu Essstörungen im Rahmen des Curriculums der Medizinischen Universität Wien finden Sie hier.

 

Es wird auch Lehre im Rahmen postgradueller Kurse (z.B. Wiener Fortbildung Essstörungen; ÖAGG; ARGE Bildungsberatung; Schulärztecurriculum; Pädagogische Hochschule) angeboten. 

 

Es werden laufend neue Diplomarbeitsthemen für Mediziner (N202) und auch andere Berufsgruppen ausgeschrieben. Bei Interesse schicken Sie bitte frühzeitig ein E-mail (wenn möglich samt kurzem Lebenslauf) an essstoerung@meduniwien.ac.at ! Danke

 

 

Diplomarbeiten 1-7 siehe —-LINK

 

(8) Diplomarbeit Frau Cand. Med. Orsolya Gal
Der Einsatz eines internetgestützten Psychoedukationsprogrammes in der Therapie von Bulimia nervosa unter Berücksichtigung psychiatrischer Komorbidität. Eine Verlaufsstudie nach 4 und 7 Monaten (approbiert August 2009) Betreuer: Univ.-Prof.
Dr Andreas Karwautz, MUW

Introduction: The present work deals with the “therapy of Bulimia nervosa focusing on comorbidities in the form of an Internet self educating program”.  The data used in this study is based on the raw data acquired in the study “Therapieforschungsprojekt: Bibliotherapie vs. Internetbasierte Psychoedukation für Mädchen und Frauen mit Bulimia nervosa” of the AK

The objective of this dissertation was to compare patients who suffer from bulimia nervosa with comorbidities with patients without comorbidities regarding the progress of bulimia nervosa, the degree of the eating disorder symptoms, the general psychopathology and the therapy outcome.

Metods: 70 women, who signed up freely for this study, participated in the “Internet self educating program”. The first time of assessment took place at the time of sign up (T0), the second after 3 months (T1) and the last after 4 months (T2). Altogether the study lasted for 7 months. The following measuring instruments were used: das strukturierte Inventar für Anorektische und Bulimische Essstörungen SIAB-Ex, die Symptom-Checkliste SCL-90-R, das Beck-Depressions-Inventar BDI, der Selbstbeurteilungsfragebogen zur Erfassung der Psychopathologie von Essstörungen EDI 2, das Eating Disorder Examination Questionaire    EDE-Q. The comorbiditiy itself was defined over the ICD-10.

Results: The prevalence of the comorbidities in the sample represented (T0) 71,5% (N = 50). The affective disorders occurred in 58,7%  of the patients (T0) with comorbidities. The study examined, that there are no significant differences between the patients with comorbidities and without comorbidities during the self educating program concerning eating disorder symptoms, the general psychopathology and the therapy outcome.
Conclusion: The study could not verify the thesis that patients with comorbidities would drop out of the program during the process than patients without comorbidities. In regard to the eating disorder symptoms both groups could benefit from the Internet self educating program.

 

(9) Diplomarbeit Frau Cand med. Martina Dieplinger
Geleitete Selbsthilfe im Internet im Vergleich zu geleiteter Selbsthilfe via Bibliotherapie bei Patienten mit Bulimia nervosa: Eine kontrollierte prospektive Studie (approbiert August 2009) Betreuer: Univ.-Prof.
Dr Andreas Karwautz, MUW

BACKGROUND: Eating disorders in general and Bulimia nervosa in particular are psychiatric diseases that primarily affect young woman. The proportion of people that suffer of Bulimia nervosa is estimated to be around 2% of the total population. At the moment, the preferred treatment is a cognitive behavioral therapy. However, since this type of therapy requires intensive care through an expert, there is a lack of available places on treatment programs. This problem initiated the search for new alternative treatments that require less time and budget. As one result a self-help approach for treating Bulimia nervosa was developed. The aim of this thesis is to analyze and to assess the effectiveness of an assisted self-help therapy by means of the internet (“Internet-Therapy”) or by means of a book (“Biblio-Therapy”) in treating Bulimia nervosa patients. Furthermore the performance of the two treatment methods shall be compared against each other.
METHOD: In order to be able to assess the effectiveness of the two proposed therapies 126 female patients with the diagnosis Bulimia nervosa (ICD 10; DSM IV) were treated either with the Internet-Therapy (N=70) or with the Biblio-Therapie (N=56). At the beginning of the therapy (pre-evaluation), after four months (evaluation 1) and after another three months (post-evaluation) the patients were asked to answer a set of questions (EDI 2, EDE-Q, SIAB). As some patients decided not to participate in the second or third survey, the final sample size at the end of the examination consisted of 82 patients.
RESULTS: An analysis of variance (ANOVA) with regard to the general and the particular psychopathology (measured by means of EDI, EDE-Q and SIAB subscales) showed significant improvements. No statistically significant difference regarding the outcome of the therapy was measured between the two examined therapy types (Internet / Biblio).
CONCLUSION: Assisted self-help therapy by means of the internet (“Internet-Therapy”) or by means of a book (“Biblio-Therapy”) are suitable alternatives next to the traditional methods in treating Bulimia nervosa patients.

(10) Diplomarbeit Frau Cand. Phil. Alice Spann (Pflegewissenschaft)
Essstörungen mit besonderer Berücksichtigung ihrer Auswirkungen auf die Reproduktivität (August 2009) Betreuer: Univ.-Prof. Dr. Andreas Karwautz, MUW


Essstörungen sind ein Phänomen, das über die Jahrhunderte hinweg in unterschiedlichen Erscheinungsformen immer wieder anzutreffen ist. Als psychosomatische Erkrankung sind sie allerdings erst seit der zweiten Hälfte des 19. Jahrhunderts bekannt. Das Auftreten einer Essstörung wird mit der westlichen, industrialisierten Wohlstandsgesellschaft assoziiert, beziehungsweise mit jenen Kulturen, die die entsprechenden Wertvorstellungen – besonders in Hinblick auf das weibliche Schönheitsideal – übernommen haben.Essstörungen treten am häufigsten bei jungen Mädchen und Frauen im gebärfähigen Alter auf. Daher ergeben sich unterschiedlichste Auswirkungen dieser Störung auf die menschliche Fortpflanzung. Mit deutlichem Unter- oder Übergewicht – im Rahmen einer Anorexia Nervosa oder einer Binge Eating Störung – geht in der Regel eine verminderte Fruchtbarkeit einher. Auch bei Bulimie Patientinnen können Fruchtbarkeitsstörungen auftreten. Die Schwangerschaft stellt eine Zeit dar, in der viele Frauen mit der ersten drastischen Veränderung ihres Körpers seit der Pubertät konfrontiert werden. Die schwangerschaftsbedingten Veränderungen von Figur und Gewicht können von allen Frauen, besonders aber von Essstörungspatientinnen, als sehr stressreich empfunden werden. In der Regel geht die Schwangerschaft allerdings mit einem Rückgang der essstörungsspezifischen Symptomatik und einer Besserung des Ernährungsverhaltens zum Wohle des ungeborenen Kindes einher. Es gilt jedoch zu bedenken, dass Frauen, die sich wegen ihrer Erkrankung nicht in Behandlung befinden, oftmals ein Fortbestehen der Essstörung im Verlauf der Schwangerschaft erleben. Dieser Umstand wirkt sich drastisch auf den Geburtsausgang aus. Eine geringe oder übermäßige Gewichtszunahme während der Schwangerschaft kann zu beträchtlichen Komplikationen bei der Geburt führen. Nach der Geburt ist bei vielen Essstörungspatientinnen, die eine Besserung ihres Zustandes im Verlauf der Schwangerschaft erlebt haben, ein Wiederaufflammen der Symptomatik festzustellen. Wichtige Faktoren, die diese Entwicklung begünstigen, sind Anpassungsschwierigkeiten an die Mutterschaft und unrealistische Vorstellungen in Bezug auf den für die Gewichtsnormalisierung nach der Geburt benötigten Zeitraum. Auch auf die Erziehung der Kinder kann eine Essstörungserkrankung der Mutter negative Auswirkungen haben, so wird etwa angenommen, dass sich gestörtes Essverhalten und Maßnahmen der Gewichtsregulation ebenso wie die Überbewertung von Figur und Gewicht im Sinne der elterlichen Vorbildwirkung auf die Kinder übertragen.
Die Pflege hat bei der Betreuung von Essstörungspatientinnen den Vorteil ihrer ganzheitlichen Herangehensweise. Was die Überwachung des Zustandes der Essstörungspatientin im Verlauf der Schwangerschaft und die unmittelbare Betreuung betrifft, sind Pflegepersonen in einer guten Position.

(11) Diplomarbeit Cand med. Sarah Sonnenstatter (MUW, N201)Angst vor Hypoglykämie als Ursache für Insulinunterdosierung und medizinische Folgekomplikationen der Insulinmanipulation (MUW, Approbiert Sept 2009, Betreuer: Univ.-Prof Dr Andreas Karwautz)

Diabetes mellitus type 1 is the most common metabolic disease of children and     adolescence. Especially in the last decade there was a worldwide increase in     expansion of the illness, because of that it is important to deal with diabetes mellitus. And don´t forget al the problems belonging to that disease. It is specially necessary to pay attention to acute  complications and long-term consequences, because they have a strong influence on life of patients, especially in psychical fields. Until now there are existing only a few cases in literature, that there is a bad metabolic control in young people, whose reasons were not analysed systematically yet. This is leading to a higher prevalence of long-term consequences in further future. For this study the statistical data of 322 children and adolescent (176 girls and 146 boys, average age 14,45 years) from Austria with the diagnose diabetes mellitus type 1 has been evaluated. It was additionally up to the questionnaires possible, to make a diagnostic interview on the phone with 241 of them. For the statistical evaluation of the fear of hypoglycaemia we used the Hypoglycemia Index (CHI), for the medical long-term consequences of insulin manipulation the medical data card. We compared two groups, the manipulators (over- and underdose and management problems) with the non-manipulators.
Children and adolescents with diabetes mellitus type 1 show in a big number fear of hypoglycaemia and that although today there are many diabetescamps (with BGAT), advanced trainings and options of information offered. Not absolutely because of that fear, but also because of other reasons, many test persons modify there insulin therapy. That currently leads only to light problems, as a worse HbA1c value, but later in adulthood to typical diabetic complications. There is only a significant   connection between fear and age, sex and severe hypoglycemia, but not of other variables.

 

(12) Diplomarbeit Cand. Med. Claudia Kollermann (N202) „Therapiezufriedenheit und Therapieerfolg in der stationären Kinder- und Jugendpsychiatrie“.   (MUW, Approbiert April 2010; Betreuer: Prof Dr Andreas Karwautz)


Background In child and adolescent psychiatry an early diagnosis and a following appropriate therapy are essential. Quality assurance and evaluation of clinical treatment therefore gain in importance, as missing or ineffective treatment results in impairments of quality of life and future perspectives.

There are very few studies concerning satisfaction with and success of inpatient treatment in child and adolescent psychiatry, and their results are diverse. Therefore further research is of great importance in order to assure the patients of effective treatment.

Methods Data of 60 inpatients in the Department of Child and Adolescent Psychiatry at the AKH Wien (26 girls and 34 boys, mean age 13,3 years, mean duration of inpatient treatment 43 days) were analysed. By means of different questionnaires completed from patients, parents or physicians, information concerning psychic problems, severity of symptoms (by YSR, CBCL), treatment success (by MSS), treatment satisfaction (by BesT KJ, ISW), motivation for change (by FEVER) and quality of life (by ILK) were collected.

Results The patients of this sample showed a significant improvement in symptoms after their inpatient treatment. Age and gender of patients also had an impact on treatment success, as girls and older patients presented a better outcome.

Treatment satisfaction was overall good, the patients rated the conversations with the physician or psychotherapist in charge as best.

A correlation between treatment satisfaction and treatment success can be found, as patients, who were more comfortable with therapeutic setting, had a better outcome. Patients, who had reported lower quality of life at the beginning of inpatient treatment, showed a better outcome after inpatient treatment.

(13) Diplomarbeit Cand med. Barbara Holzer (N202) “Anorexia nervosa. Therapiemotivation als Einflussfaktor auf Symptomveränderung bei PatientInnen mit Anorexia nervosa in einem stationären  Setting” (approbiert an der MedUni Wien April 2010; Betreuer: Prof Dr Andreas Karwautz)

The main ambition was to analyze symptom-deviation after treatment concerning motivation for therapy before and after treatment within the framework of a pre-post design study. First inpatients who were in a specific treatment programme for anorexia had to undergo a semi-structured interview (EDE) conducted by two students at the beginning and the end of their stay. Second the inpatients had to fill in the anorexia stages of change questionnaire (ANSOCQ) at the beginning and the end of their therapy. Third, the patients’ parents received the child behaviour check list (CBCL) to rate their children’s behaviour. The EDE and the ANSOCQ were used to examine motivation for therapy and change of symptoms. The CBCL was handed out to demonstrate the difference between the inpatient’s view of illness and the parents’ attitude towards and their opinion concerning their child. Above that the CBCL was a good means of showing the range of comorbidities which existed in the examined patients.
Results : There was no significant correlation between motivation and the BMI at the beginning of the stay. Nonetheless the results showed that the scale of Maintenance, which means the wish to maintain the weight, kept on rising with a higher BMI. The highest mean at the beginning of the stay was found on the precontemplation scale which showed that the main part of the patients was in the first phase of motivation. The patients’ motivation at T0 didn’t show any significant effects on the change of the EDE scales which indicate symptom-deviation. Preparation was the only scale where significant difference between T0 and T1 was found (from 3,61 to 1,29). The age of the patients didn’t correlate with any level of motivation. At admission the scales Restraint, Eating Concern and Shape Concern showed significant differences regarding the clusters of motivation which were formed for means of distinction. Therefore patients with lower motivation had higher means on each of the three scales. Comparing the EDE results at the time of admission and of discharge, a significant change concerning the scales of Restraint, Eating Concern and Shape Concern could be noticed. The length of stay (mean 37,64 days) had nothing to do with any change of symptoms. Only the scale Restraint showed a bigger difference after a longer stay. The BMI developed independently from age to a mean from 14,75 to 16,45. The existence of an internal disorder had no significant influence on the alteration of the BMI. It was proved that patients with lower motivation scales elevated their BMI in the same way as patients without good motivation did. Clinically noticeable was a mean T-Score of 64,4 concerning the total scale of internal disorders. In the Cut-Off, internal disorders amounted to 50%. The biggest group among internal disorders were the schizoid-anankastic disorders (42%), followed by anxious-depressive disorders (29%) and social withdrawal (25%). Patients with internal disorders had lower means on the Maintenance scale in comparison to patients without internal disorders. Unexpectedly patients with these disorders presented higher levels in the scale of Preparation.
Conclusions: As it was supposed to be the symptoms of AN had become better at the end of the therapy. Notwithstanding the power of motivation was not significantly linked to the curation of the inpatients. The amelioration and the gain of weight can certainly be led back to the strict eating plan and the few possibilities to fool the nurses or cheat the eating programme. In fact it can’t be judged whether motivation is a significant influence concerning the outcome or not because the sample of patients was hardly big enough to make any assumptions. The existence of internal disorders didn’t show any statistically relevant effect on the changes of the EDE-scales. The length of the stay strongly correlated with changes in the scale Restraint and clearly showed that a longer stay could change patients’ thought patterns.

 

 

WEITERE ab Nr. 1– 7 unter  —LINK

14f—LINK

Univ.-Prof. Dr. Andreas Karwautz

Diplomarbeiten zu Essstörungen (MUW)