Determinants of health-related quality of life in patients with persistent somatoform pain disorder

Background. Health-related quality of life (HRQOL) has been investigated widely in patients with chronic pain, but no study has focused particularly on the situation of patients with persistent somatoform pain disorder. Aims. To survey the impairments of patients with somatoform pain disorder (ICD-10: F45.4) and to predict pain-related impairments and HRQOL on the basis of coping styles. Method. A consecutively recruited sample of 100 patients (65% female) was examined in a cross-sectional study. Questionnaires were administered to assess pain intensity (visual analogue scale), pain-related disabilities (Pain Disability Index), quality of life (Short-Form Health Survey-36), and ways of copi…

Cerebral activation in patients with somatoform pain disorder exposed to pain and stress: an fMRI study.

Patients with somatoform pain disorders are supposed to suffer from an early acquired defect in stress regulation. In order to look for common alterations of the pain- and stress-responsive cortical areas, we prospectively recorded cerebral activations induced by pin-prick pain, by cognitive stress and emotional stress using functional magnetic resonance imaging (fMRI) in a group of 17 patients and an age-matched control group. In addition, the hippocampal volumes of both groups were measured. Patients showed increased activations of the known pain-processing areas (thalamus, basal ganglia, operculo-insular cortex), but also of some prefrontal, temporal and parietal regions during first pai…

Prädiktoren der Lebensqualität nach orthopädischer Behandlung lumbaler "bandscheibenbedingter" Rückenschmerzen/ Predictors of quality of life after orthopedic treatment of lower back pain due to lumbar intervertebral disc disorders

Zusammenssung Fragestellung: Untersuchung der pradiktiven Bedeutung organpathologischer, psychischer und psychosozialer Parameter fur die Lebensqualitat bei Katamnese von Patienten mit lumbalen "bandscheibenbedingten" Beschwerden. Methode: In dieser prospektiven Studie wurden 109 Patienten mit lumbaler "bandscheibenbedingter" Schmerzsymptomatik vor und ein Jahr nach stationarer orthopadischer Behandlung hinsichtlich ihrer Lebensqualitat und psychischen Belastung untersucht. Der Behandlungserfolg wurde mit Hilfe der deutschen Version des Short Form Health Survey (SF-36), die psychische Belastung mit Hilfe der Symptom-Checkliste 90 (SCL-90-R) und die Krankheitsbewaltigung mit Hilfe des Freibu…

The relevance of anxiety, depression, and coping in patients after liver transplantation

The aim of this study is to investigate the effects of anxiety, depression, and coping on quality of life in patients after liver transplantation. Patients were asked to fill out a postal survey. Two hundred thirty-six of 375 patients (63%) who entered the study returned the questionnaires, and 186 of these patients could be included in the assessment. Anxiety and depression were surveyed using the Hospital Anxiety and Depression Scale; health-related quality of life, using the 36-Item Short-Form Health Survey; and coping strategies, using the Freiburg Questionnaire on Coping With Illness. In terms of physical and mental dimensions of health-related quality of life, psychosocial factors are…

Krankheitsbewältigung bei Patienten nach Lebertransplantation unter Berücksichtigung der Zugehörigkeit zu einer Selbsthilfegruppe

Background: Within the past 15 years, liver transplantation has proven itself to be the treatment of choice among patients with terminal liver disease. The one-year survival rate is about 80%; after 8 years 61 % of the patients are still alive. The present study investigates the influence of active or depressive coping on the physical and mental quality of life in two different groups of patients after liver transplantation. Methods: Members (n = 65) and non-members (n = 2,0) of a German self-help group were asked to fill out a postal survey. Patients were included if their liver transplantation was conducted 6 to 36 months ago. The health-related quality of life was surveyed using the SF-3…

Somatosensory profiles in subgroups of patients with myogenic temporomandibular disorders and Fibromyalgia Syndrome.

Some patients with myofascial pain from temporomandibular disorders (TMD) report pain in extra-trigeminal body regions. Our aim was to distinguish TMD as regional musculoskeletal pain syndrome (n=23) from a widespread pain syndrome (FMS; n=18) based on patients' tender point scores, pain drawings and quantitative sensory testing (QST) profiles. Referenced to 18 age- and gender-matched healthy subjects significant group differences for cold, pressure and pinprick pain thresholds, suprathreshold pinprick sensitivity and mechanical detection thresholds were found. Pain sensitivity in TMD patients ranged between those of FMS patients and healthy controls. The group of TMD patients was inhomogen…

Influence of childhood adversities and defense styles on the 1-year follow-up of psychosomatic- psychotherapeutic inpatient treatment

Abstract The current study explores the connection between reported sexual abuse and physical maltreatment during childhood and immature defense styles as affecting the 1-year follow-up of inpatients who had undergone psychodynamic group therapy. Early traumatization was assessed using a structured patient interview and the defense styles by means of the questionnaire on defense styles. Reduction in psychological distress and improvement in health-related quality of life formed the parameters against which success of treatment was measured. At the 1-year follow-up, the entire sample showed a distinct improvement. The effect sizes for health-related quality of life ranged from 0.82 to 1.21, …

Konfliktbewältigung als pathogenetisches Bindeglied zwischen psychosozialen Belastungen in der Kindheit und psychischen Erkrankungen im Erwachsenenalter/ Coping with conflict as pathogenetic link between psychosocial adversities in childhood and psychic disorders in adulthood

Zusammenfassung Fragestellung: In der vorliegenden Studie wird der Zusammenhang zwischen neurotischen beziehungsweise unreifen Konfliktbewaltigungsstrategien mit spezifischen psychosozialen Belastungen in der Kindheit und deren kumulative Wirkung untersucht. Es wird dabei die Hypothese uberpruft, ob bestimmte Konfliktbewaltigungsstrategien als pathogenetisches Bindeglied zwischen psychischer Erkrankung im Erwachsenenalter und psychosozialen Belastungen und Traumatisierungen in der Kindheit angesehen werden konnen. Methode: 407 konsekutiv in der Ambulanz einer psychosomatischen Universitatsklinik untersuchte Patienten konnten nach abgeschlossener Diagnostik und Klassifikation nach ICD-10 in …

Stationäre verhaltenstherapeutisch-psychodynamische Kombinationsbehandlung

In der Psychosomatischen Klinik des Mainzer Universitatsklinikums werden Patienten bestimmter Diagnosegruppen mit einer Kombination aus psychodynamischen und verhaltenstherapeutischen Therapiekonzepten behandelt. Diese modellhafte Kombination beider Verfahren wird bei Patienten mit Zwangsstorungen und Angststorungen angewendet und im folgenden am Beispiel eines Patienten mit einer Agoraphobie und einer narzistischen sowie selbstunsicher-abhangigen Personlichkeitsstorung beschrieben. Das Behandlungskonzept beruht auf der Annahme, das zumindest eine Subgruppe von Patienten von einer Kombinationsbehandlung mehr profitiert als von einem der genannten Therapieverfahren alleine. Auf der Ebene der…

Health-Related Quality of Life and Somatization in Patients With Long-Term Low Back Pain

Study Design. For this study, a prospective cohort of 109 patients was recruited consecutively at an orthopedic inpatient unit of a university hospital. Three self-report instruments were administered to patients with sciatica believed to be caused by a herniated lumbar disc to examine their quality of life and psychic stress at baseline and at the 1-year follow-up visit. Objectives. To investigate whether patients who have undergone a previous discectomy experience greater psychic stress than patients with no surgery, and to determine whether the groups differed regarding their health-related quality of life at the follow-up visit. Summary of Background Data. Previous studies have describe…

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Manualized psychodynamic-interactional group therapy for the treatment of somatoform pain disorders.

Medically unexplained and clinically significant symptoms of pain are highly prevalent in the general population. More than one third of all patients in general practices and various departments of hospitals suffer from somatoform disorders with pain being the main complaint of 70% of these patients. This treatment manual is the first disorder-specific, psychodynamically oriented treatment for these patients. Based on psychodynamic-interactional group psychotherapy, it focuses on disorder-specific aspects as well as on psychic and interpersonal problems which have resulted from adverse childhood experiences and insecure attachment. In three treatment phases comprising an “information and mo…

Attachment characteristics and treatment outcome following inpatient psychotherapy: Results of a multisite study

Abstract The authors evaluated 617 patients at hospital admission using an interpersonal interview analyzed with the Adult Attachment Prototype Rating (Strauss, Lobo-Drost, & Pilkonis, 1999) in nine different psychotherapeutic hospitals. Attachment characteristics derived from this method served as predictors of treatment outcome. Outcome was quantified in all sites using the Symptom Checklist-90-Revised, Inventory of Interpersonal Problems, and, in a subsample, the Impairment Score (Schepank, 2003) as an observer rating. All measures were administered at patient admission and discharge. Additionally, patients completed the Bielefeld Questionnaire of Client Expectations (BQCE) at admission …

Psychological defense styles, childhood adversities and psychopathology in adulthood.

OBJECTIVE: The present study explores the link between reported sexual and/or physical abuse and psychological defense styles, as well as the association of both with psychological distress in adulthood. In two patient samples that differ in psychological distress and somatization, we examine whether the adversities reported and immature defense styles are associated with psychopathological symptoms. METHOD: We examined 266 consecutive inpatients in the psychosomatic department and 109 consecutive inpatients who had been treated for low-back pain in the orthopedic department of a German university hospital. Psychological defense styles were assessed by a two-factor solution of the German mo…

Three-dimensional crystallization of the light-harvesting complex from Mantoniella squamata (Prasinophyceae) requires an adequate purification procedure

Abstract We present a new purification procedure for the light-harvesting complex of Mantoniella squamata whereupon three-dimensional crystallization succeeded. Previous purification methods were based on density centrifugations as the only separating principle. We have extended this preparation procedure by applying anion-exchange and molecular-sieve chromatography techniques. Purity and stability of the complex were proved by denaturing and non-denaturing polyacrylamide-gel electrophoresis, and spectroscopic measurements. With respect to contaminating lipids the purified pigment-protein complex was examined by thin-layer chromatography and the aggregation and/or oligomeric states were inv…

Are childhood adversities relevant in patients with chronic low back pain?

Abstract Previous studies have found a high number of childhood adversities in patients with chronic low back pain, particularly in patients reporting persisting problems after back surgery. Our aim was to reproduce these results. Within the framework of a comprehensive diagnostic assessment and psychometric evaluation, 109 inpatients who had been treated for low back pain were examined in the orthopedics department of a German university hospital. Five risk factors investigated by Schofferman and his staff (Schofferman et al ., 1993) were re-assessed in all of our patients using a structured biographical interview. The German chronic low back pain group was also compared with an age- and g…