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The S3 guideline "Dealing with patients with non-specific, functional and somatoform bodily symptoms" emphasizes the similarities in the management of the manifold manifestations of so called "medically unexplained symptoms" and gives recommendations for a stepped and collaborative diagnostic and therapeutic approach in all subspecialties and all levels of health care. It has a special focus on recommendations regarding attitude, physician-patient-relationship, communication, the parallelization of somatic and psychosocial diagnostics and a stepped therapeutic approach. The "Evidence-based guideline psychotherapy in somatoform disorders and associated syndromes" provides a differentiated analysis of the current evidence regarding the effectiveness of various psychotherapeutic interventions for the most relevant manifestations of functional and somatoform disorders. In combination, both guidelines pose important advances for treatment quality in Germany, but also illustrate remarkable structural and research deficits.

Background: Culture has been shown to influence climacteric symptoms of women. This cross-cultural study compared the climacteric symptoms, self-esteem and perceived social support between Mosuo and Han Chinese women and explored the culture impact on these variables. Mosuo is a Chinese minority with matriarchal structure and Han Chinese is the majority ethnic group of China with patriarchal structure. Method: Through convenience sampling, 54 Mosuo women and 52 Han Chinese women aged between 40 and 60 completed the sociodemographic questionnaire, Menopause Rating Scales (MRS), Self-Esteem Scale (SES) and Perceived Social Support Scale (PSSS). Results: As compared to Han Chinese women, Mosuo women scored lower in psychological and somato-vegetative factors of the MRS, but higher in the SES and the "intra family support" factor of PSSS. Multilinear regression indicated that in Mosuo group high severity of climacteric symptoms was correlated with low self-esteem, while in Han Chinese group high severity of symptoms was correlated with low self-esteem, little perceived intra family support and the history of premenstrual symptoms. Conclusion: Mosuo women during climacteric showed better health status, higher self-esteem and perceived more intra family support compared with Han Chinese women. The predictors of the severity of the climacteric symptoms were different in each ethnic group respectively, which could be related to cultural diversity in the interaction between symptom severity and psychological characteristics.

ZusammenfassungFUNKTIONAL stellt im Rahmen des Forschungsverbunds Allgemeinmedizin eines der vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Projekte der Universität Heidelberg dar, welches in einer Kooperation von Hausärzten und Psychosomatikern ein Curriculum zur Früherkennung und Behandlung somatoformer/funktioneller Beschwerden für Allgemeinärzte entwickeln, durchführen und evaluieren will. Die Diagnostik und Therapie somatoformer/funktioneller Erkrankungen gestaltet sich für die Behandler oftmals schwierig und unbefriedigend, und es entstehen durch Mehrfachdiagnostik, Fehlbehandlung und Fehlzeiten erhebliche Kosten für die Sozialversicherungssysteme. Hausärzten kommt daher besonders bei dieser Patientengruppe eine zentrale Screening-, Filter-, Präven-tions-und Behandlungsfunktion zu. Ziel dieser Studie ist es, durch die gezielte, an Leitlinien und der Praxis mitsamt Praxisteam orientierte, Schulung von Hausärzten die Diagnostik und Behandlung dieser Erkrankungen zu optimieren sowie die Zufriedenheit und die Lebensqualität der Patienten zu erhöhen. Die Implementierung und Evaluation der Inhalte des Curriculums wird in einem randomisierten kontrollierten Design durchgeführt, um kurz-und mittelfristige Effekte der Intervention auf der Ebene der Patienten und Behandler systematisch erfassen zu können. SchlüsselwörterFunktionelle Störung · somatoforme Störung · Forschungsprojekt · Weiterbildung · Allgemeinmedizin Abstract Promoted by the German Federal Ministry of Education and Research FUNKTIONAL is a project of the "Forschungsverbund Allgemeinmedizin" of Heidelberg University. In a cooperation of general practitioners and psychosomatic clinicians this project wants to develop, carry out and evaluate a curriculum which will help general practitioners to recognize and treat somatoform/functional complaints as early as possible. The diagnostics and therapy of somatoform/functional disorders is often difficult and unsatisfactory for the attending doctor. Multiple diagnostics, inadequate treatment and times absent from work create high costs for the social security system. Especially with this group of patients general practitioners have responsibility in terms of screening, filtering, prevention and treatment. The study aims at optimizing diagnostics and treatment and at increasing the patients' satisfaction and quality of life with a training of general practitioners, based on guidelines and practical experience. The contents of the curriculum are implemented and evaluated within a randomized controlled trial. This way short-and middle-term effects of the intervention regarding the patients as well as doctors can be systematically recorded.

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