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…

Psychotherapie und ihre Wirksamkeit bei chronischen Schmerzzuständen

Der Paradigmenwechsel bei Schmerz von einem linear-kausalen zu einem kybernetischen Modell fuhrte zu einer verstarkten Berucksichtigung der Erforschung seelischer Faktoren in der Genese und Aufrechterhaltung chronischer Schmerzzustande. Dadurch entwickelte sich ein zunehmendes Interesse an der Wirksamkeit psychotherapeutischer Verfahren bei Patienten mit chronischem Schmerz. Die Arbeit gibt einen Uberblick uber die heute am haufigsten eingesetzten Psychotherapieverfahren (Hypnose, Entspannungsverfahren, verhaltensthera-peutische Verfahren, psychoanalytisch orientierte Verfahren), ihre theoretischen Ansatze, ihre Durch-fuhrung sowie ihre bisher nachgewiesene Wirksamkeit. Die psychoanalytisch…

The “Mainzer EMF-Wachhund”: results from a watchdog project on self-reported health complaints attributed to exposure to electromagnetic fields

The "Mainzer EMF-Wachhund," a watchdog project, offered a system of self-notification of health complaints attributed to exposures to electromagnetic fields (EMFs) to a population of a part of Germany with about 4 million inhabitants. By using a self-administered questionnaire, which was provided online and for download from the Internet, 192 persons reported such health complaints in the period from October 2003 to March 2005. Of these, 56% classified themselves as electromagnetic hypersensitive (EH). Predictors of this self classification were being affected by all kinds of EMF rather than single EMF sources and being female. On average, EH subjects reported a high degree of suffering, 77…

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…

73-COPING WITH TYPE 1 DIABETES: RESULTS OF THE GERMAN MULTICENTER DIABETES COHORT STUDY.

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…

Psychosoziale Risiko- und Schutzfaktoren in Kindheit und Jugend als Prädisposition für psychische Störungen im Erwachsenenalter

Longitudinal and well-controlled cross-sectional studies have shown that numerous psychosocial stress factors in childhood and youth affect psychic health in the long term. The significance of compensatory protective factors has also been well documented in various studies. An overview of this work is presented: the factors which need to be clarified and taken into consideration in the diagnosis of psychic disorders have been summarized and critically analyzed on the basis of the results of more recent studies of the significance of sexual traumatization.

Quality of Life and Health in Patients with Urinary Diversion: A Comparison of Incontinent versus Continent Urinary Diversion

Objective: To compare the quality of life and health in patients with incontinent and continent urinary diversions, in correlation with the initial diagnosis, diversion-related symptoms, psychological status and employment status. Materials and Methods: 81 patients (64% male and 36% female) with a mean age of 55 years (18-65 years) were included in this retrospective study. A total of 27 had an incontinent urinary diversion (group A) and 54 a continent diversion (group B). The initial diagnosis was malignant tumor in 75% (n = 61) and nontumor disease in 25% (n = 20). A structured interview and psychometric instrument assessment of the quality of life as well as somatic and psychological sym…

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 …

Adaptation to life after surgical removal of the bladder—an application of graphical Markov models for analysing longitudinal data

Graphical Markov models have been developed particularly for the analysis of observational data. They allow the control of various background variables when analysing theoretically relevant associations. This paper demonstrates the application and some advantages of graphical Markov models in comparison to conventional statistical analyses. The aim of the study was to identify patients at risk for developing decreased health-related quality of life (QoL) after cystectomy and to explore the influence of coping on QoL in this situation. Therefore, the method was applied to analyse the data of a prospective study, in which 81 patients with bladder cancer were interviewed pre-operatively and in…

Kreuzvalidierung des “Fragebogen zur Messung der psychosozialen Belastungen bei chronisch-entzündlichen Darmerkrankungen (FBCED)“ an einer nationalen Stichprobe

Zusammenfassung. Theoretischer Hintergrund: Der “Fragebogen zur Messung der psychosozialen Belastungen bei chronisch-entzündlichen Darmerkrankungen“ (FBCED) erfasst Alltagsbelastungen bei Patienten mit chronisch-entzündlichen Darmerkrankungen (CED). Fragestellung: Überprüfung der Faktorenstruktur des FBCED. Methode: Faktorenanalytische Kreuzvalidierung an einer Stichprobe von 1322 CED-Patienten. Ergebnisse: Skalenstruktur und psychometrische Kennwerte der FBCED-Skalen (Affektive Verstimmung, Arzt-Patient-Verhältnis, Angst vor Darmkontrollverlust, Berufliche Beeinträchtigung, Sorge um Krankheitsverschlimmerung, Belastung durch medizinische Maßnahmen, Beeinträchtigung der Sexualität/Partners…

Impaired Health-Related Quality of Life in Inflammatory Bowel Diseases Psychosocial Impact and Coping Styles in a National German Sample

The purpose of this study is to give a detailed survey of the disease-specific and generic quality of life (HRQOL) of adult patients suffering from inflammatory bowel disease (IBD) in Germany.1322 patients suffering from IBD were examined in a cross-sectional study. A questionnaire assessing disease-specific and generic quality of life, coping, and hopelessness was sent to members of the German Crohn/Colitis association.Compared to the general population, the generic HRQOL in IBD patients is significantly reduced. Active coping has a negative influence on patients' generic physical HRQOL during an active phase (beta = -0.31), while this association is not present in the case of patients in …

Checkliste zur Bewertung der wissenschaftlichen Qualität kontrollierter psychotherapeutischer Interventionsstudien (CPI)

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…

Health-related quality of life in patients with chronic fatigue syndrome

Objective: Chronic fatigue syndrome (CFS) has been reported worldwide. Our objectives were to determine if patients from different countries have similar profiles of impairments. Methods: Health-related quality of life (HRQoL) was assessed in 740 CFS patients in the US, 82 in the UK, and 65 in Germany using the eight subscales of the Short-Form General Health Survey (SF-36). To examine the internal structure, factor analyses were performed. Results: Overall, there was a remarkable similarity in HRQoL among all CFS patients, regardless of location. Patients scored two to three standard deviations below normal on six subscales and one standard deviation below normal on the other two subscales…

Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome.

Objectives: To evaluate cerebral glucose metabolism, assessed by 18-fluorodeoxyglucose positron emission tomography (FDG-PET), in patients with chronic fatigue syndrome (CFS), using an observer independent analytical approach; and to characterise any observed alterations by correlating them with neuropsychological deficits. Methods: 26 patients (13 female, 13 male) were examined. They all fulfilled the CDC diagnostic criteria for CFS. Their ages ranged from 26 to 61 years (mean (SD) age, 43 (9.3) years). They underwent extensive psychometric testing including the hospital anxiety and depression scale (HADS) and the short form 36 item health questionnaire (SF-36). Brain FDG-PET was done in a…

Stress as a Key Concept in Chronic Widespread Pain and Fatigue Disorders

ABSTRACT.Objectives: To review recent studies on the etiopathogenetic role and clinical relevance of life stress in medically unexplained syndromes characterized by chronic widespread musculoskeletal pain and fatigue.Findings: Both fibromyalgia syndrome [FMS] and chronic fatigue syndrome [CFS] have been found to be frequently linked to different stressors, such as negative life events, occupational problems, posttraumatic stress [PTSD], adverse childhood experiences, and “overactive” lifestyle. In addition, the stress-modulating role of affect-regulation, perceptual-cognitive factors, and social support, as well as the relationship with depression have been investigated in FMS/CFS patients.…

176-INPATIENT PSYCHOTHERAPY: INFLUENCE OF CHILDHOOD ADVERSITIES AND COPING WITH CONFLICT ON OUTCOME.

Metabolic and psychosocial effects of minimal invasive gastric banding for morbid obesity

Obesity is considered a primary risk factor for cardiovascular disease and related mortality. The current study aimed to investigate the efficacy of minimal invasive gastric banding (GB) surgery for reducing caloric intake in morbid obesity, and to analyze the effects of weight loss on body composition and metabolic and psychosocial outcomes. Twenty-six adult severely obese patients (mean body mass index [BMI], 48.1 kg/m(2); range, 42 to 56) underwent adjustable silicone laparoscopic GB. Nine additional obese patients who declined surgery were treated with metformin (2 g daily) and served as a small additional group (BMI, 50.5 kg/m(2); range, 41 to 68). Presurgery and 17 +/- 2.2 months post…

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…

Stabilität und Stimmungsabhängigkeit retrospektiver Berichte elterlichen Erziehungsverhaltens

Zusammenfassung. Theoretischer Hintergrund: Retrospektiver Daten zum elterlichen Erziehungsverhalten sind in klinischer Psychologie und Psychotherapieforschung von Bedeutung, da Zusammenhänge zur Manifestation psychischer Störungen im Erwachsenenalter bestehen. Fragestellung: Bleibt das retrospektiv berichtete Erziehungsverhalten zeitlich stabil und welchen Einfluss nimmt die aktuelle Stimmung auf die Einschätzung? Methode: 105 Patienten wurden zu zwei Zeitpunkten im mittleren Abstand von 2,2 Jahren anhand des Kindheitsfragebogens und der Symptom-Checkliste-27 befragt. Ergebnis: Die Einschätzung des Erziehungsverhaltens weist in fast allen der erfassten Erziehungsstildimensionen hohe Stabi…

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…

Risikofaktoren und protektive Faktoren f�r die Neurosenentstehung

Eine erste Ubersicht zu Risikofaktoren und protektiven Faktoren in der biographischen Entwicklung fur spatere psychische und psychosomatische Erkrankungen im Erwachsenenalter wird vorgestellt. Offene Fragen in bezug auf die Datenerhebung sowie deren Gewichtung und Evaluation werden angesprochen.

Prevalence of psychiatric disorders in an onset cohort of adults with type 1 diabetes

Previous studies indicate a high prevalence of psychiatric disorders in adults with type 1 diabetes mellitus. The aim of our study was to determine if newly diagnosed adults with type 1 diabetes already have an elevated rate of psychiatric disorders at the beginning of their physical illness.The authors consecutively recruited 313 newly diagnosed, adult inpatients with type 1 diabetes (age 17-40 years) from 12 hospitals. A national, representative population sample of 2046 persons of a similar age range served as the reference group. Psychiatric disorders were measured in both groups using structured interviews that provided diagnoses according to DSM-IV.There was a point prevalence of 12.5…

Was misst der FKV?

Zusammenfassung. Theoretischer Hintergrund: Der Fragebogen zur Krankheitsverarbeitung (FKV-LIS; Muthny, 1989 ) ist ein im deutschsprachigem Raum häufig eingesetzter Fragebogen zur Messung von Krankheitsbewältigung. Fragestellung: Das Ziel der vorliegenden Studie ist die Überprüfung der Subskalen-Reliabilität und -Spezifität bei unterschiedlichen Erkrankungsgruppen. Methode: Die Gütekriterien der FKV-LIS Skalen werden bei Patienten mit chronisch-entzündlichen Darmerkrankungen (n = 1265), Typ-I-Diabetes (n = 552) oder Harnblasenkarzinom (n = 81) berechnet. Konvergente und divergente Trennschärfen der einzelnen Items werden analysiert. Ergebnisse: “Aktive Bewältigung“ und “Depressive Verarbei…