Effect of psychotherapy on the course of Crohn's disease. Results of the German prospective multicenter psychotherapy treatment study on Crohn's disease. German Study Group on Psychosocial Intervention in Crohn's Disease.

BACKGROUND: Our aim was to study the influence of psychotherapy in addition to a standardized corticosteroid treatment on the somatic and psychosocial course of Crohn's disease. METHODS: In a prospective, randomized multicenter study 108 of 488 patients received either drug treatment or, in the intervention group, additionally psychotherapy in the first half of the 2-year follow-up period. RESULTS: Eighty-four patients (77.8%) completed the somatic and 81 (75%) the psychosocial follow-up. Twenty-three per cent of the control group and 30% of the psychotherapy group showed episode-free courses; 29% and 17%, respectively, underwent surgery due to failure of drug treatment. The main analysis, which was based on subranking by number, duration, and severity of relapses, failed to show significant differences between the two groups (P = 0.125). The same result was obtained for the psychosocial status after 1 year in the main target criteria depression, anxiety, psychosocio-communicative status, and quality of life. CONCLUSIONS: The confirmatory analysis did not prove significantly better courses after additional psychotherapy. There was a tendency towards fewer operations.

Movement behaviour of patients with eating disorders and inflammatory bowel disease: a controlled study.

BACKGROUND: This study assessed the movement behaviour of patients with eating disorders and inflammatory bowel disease. METHODS: Ninety female patients with anorexia nervosa (n = 30), bulimia nervosa (n = 30), inflammatory bowel disease (n = 30) and a healthy control group (n = 30) were videotaped during a 10-min standardised movement sequence. A movement analysis instrument was developed for the evaluation. RESULTS: The patient groups had a significantly smaller area of movement, less weight shift, more isolated use of their body parts, less integration of the lower body, more peripheral initiation of movement, less strength. No significant differences could be found among the patient groups with eating disorders and inflammatory bowel disease. CONCLUSIONS: The findings are discussed in relation to body scheme disturbances and inhibition of nonverbal expression.

[Description of musical expression and initial results of the Lübeck music therapy model]. / Beschreibung des musikalischen Ausdrucks und erste Ergebnisse im Lübecker Musiktherapiemodell.

In the Medical University of Lübeck (Germany), T. Maler developed a music group therapy, which was based on psychoanalytic theories. In the years from 1984-1991, the behavior of 200 patients in the music therapy was assessed by means of new constructed rating scales. The patients had different kinds of psychosomatic and psychiatric disorders. The results show significant changes in the music playing behavior after 10 sessions of music therapy. The patients playing was louder, more free in the improvisation and showed more plasticity. There were no differences between the different diagnostic groups in the study.

[The significance of recurrence-inducing events for patients with chronic inflammatory bowel diseases. Results of a prospective longitudinal study over three years]. / Die Bedeutung rezidivauslösender Ereignisse bei Patienten mit chronisch entzündlichen Darmerkrankungen. Ergebnisse einer prospektiven Längsschnittstudie über drei Jahre.

This study examined whether life event stress under general or more specific conditions (fear of separation, feeling of being under pressure, feeling of being caught between two quarreling parties, separation experiences) contribute to the aggravation of inflammatory bowel disease. Firstly, 51 patients with ulcerative colitis, 57 patients with Crohn's disease, and 60 controls were compared in terms of these variables. In addition, the IBD patients filled out questionnaires regarding life events, the specific psychological conditions mentioned above, and their symptoms several times in the three years after the first measurement. By means of group comparisons and intraindividual correlations between relapse precipitating life events and illness activity, only feelings of being under pressure showed a modest correlation to the disease activity. We conclude that the variables in question have little influence on the beginning of the relapse.

Relapse-precipitating life events and feelings in patients with inflammatory bowel disease.

This study examined whether life event stress under general or more specific conditions (fear of separation, feeling of being under pressure, feeling of being caught between two quarreling parties, separation experiences) contribute to the aggravation of inflammatory bowel disease (IBD). Firstly, 51 patients with ulcerative colitis, 57 patients with Crohn's disease, and 60 controls were compared in terms of these variables. In addition, the IBD patients filled out questionnaires asking for life events, the specific psychological conditions mentioned above, and their symptoms every 3 months for 1 year after the first measurement. Patients with Crohn's disease and patients with ulcerative colitis reported a lower amount of life event stress than members of the control group, but listed more feelings of being under pressure. Within group comparisons between patients in relapse and patients in remission, as well as comparisons between patients with recently increased disease activity and patients without increased disease activity did not yield clear results. We conclude that the variables in question have little influence on the beginning of a relapse.

[Social integration of patients with anorexia nervosa and bulimia]. / Die soziale Integration von Patientinnen mit Anorexia nervosa und Bulimie.

The current study investigated the psychological and social problems of 46 patients with anorexia nervosa and 34 patients with bulimia who met the DSM III-criteria. Data were compared with 50 normal controls, using the "Fragebogen zur Sozialen Integration" (FSI, a German translation of the social adjustment scale-self report) and the Freiburger Persönlichkeitsinventar (FPI, a German personality questionnaire). Women with anorexia nervosa as well as patients with bulimia demonstrated a significant impairment in all areas of social relationships, while there were no differences between these patient groups. On the FPI, both groups reported significantly more depressed, feelings of being nervous, neuroticism and femininity, less sociable and calm than the controls.

[Social integration of Crohn disease and ulcerative colitis patients. Study of the relations of somatic, psychological and social factors]. / Soziale Integration von Morbus Crohn- und Colitis ulcerosa-Patienten. Studie zur Wechselwirkung somatischer, psychischer und sozialer Faktoren.

63 patients with Crohn's disease and 58 patients with ulcerative colitis were tested with the "Fragebogen zur sozialen Integration" (FSI, questionnaire of social adjustment), the "Freiburger Persönlichkeitsinventar" (FPI) and a semistandardized interview and were compared with surgical controls. Activity, course and symptoms of the disease were registered. We found significant restrictions in working and lesiure activities, partnership and sexual life in patients with inflammatory bowel disease. Social adjustment of patients with Crohn's disease was more dependent on disease activity than in patients with ulcerative colitis. Social impairment in patients with Crohn's disease correlated with higher stool frequency and abdominal pain, in patients with ulcerative colitis with reduced general state of health, tiredness and limpness. In the "Freiburger Persönlichkeitsinventar" (FPI) the patients with chronic inflammatory bowel disease described themselves significantly more nervous, inhibited, reserved and less aggressive, sociable and composed. The FPI scores in patients with Crohn's disease depended more on disease activity and on somatic symptoms than in patients with ulcerative colitis.

[Effect of compliance on treatment with autogenic training]. / Der Einfluss der Compliance auf die Behandlung mit autogenem Training.

Autogenic therapy courses for patient with psychosomatic psychoneurotic disorders show a high dropout rate. A study among 38 ambulant patients analysed factors of the patients have influence on their compliance. Generally the dropout group, independent of the diagnosis, shows less striking deviations. Under autogenic therapy the compliance-positive group achieves a constructive change towards normality. Realisation of autogenic therapy is achieved by patients with more intensive psychoneurotic disorders. They experience a more distinct physical answer by the basic training. It is shown that it is easier for the compliant patient to learn the autogenic therapy, which is understood as conditional response. With reference to the experience in drug compliance the results recommend that autogenic therapy should be accompanied by a compliance therapy.

[Type 1 diabetes mellitus and bulimia--a life-threatening double illness]. / Diabetes mellitus Typ I und Bulimie--eine bedrohliche Doppelkrankheit.

Among 339 patients with anorexia nervosa and 208 with bulimia there were 11 (ten females) with both bulimia and type I diabetes. In all of them it proved impossible, often over many years, to control the wide swings in the carbohydrate metabolic state, resulting in often severe diabetic complications. From one to 15 years elapsed before a diagnosis of bulimia was made. In three patients the eating disorder had preceded the onset of manifest diabetes. Six patients did not vomit, a common sign of bulimia: they "regulated" their weight via renal glucose loss or even by manipulating insulin dosage. Psychotherapy had a favourable effect on the diabetes in six patients, three continued to need treatment, while two failed to undergo treatment.

[Comparative psychodiagnostic test study in acute and chronic asthma patients]. / Vergleichende psychodiagnostische Testuntersuchung bei akuten und chronisch Asthmakranken.

The psychic characteristics of patients suffering from asthma bronchiale have mostly been investigated without considering the duration of the illness. So the question was if and in which way the duration of the disease influences the patient's psychic state. 61 asthmatics were examined by the FPI and by a structured interview. Two parallel groups with a duration of illness of less than two years respectively more than five years were compared with each other. Obviously frankness and self-criticism were to be found more frequently in the chronic group than among the patients of the short continuance of the disease. The lower frankness and willingness to self-criticism of this group of patients is also symptomatic of the first reaction to the sudden onset of the illness. The patients' first reactions are denial and repression, especially concerning the psychic parts in the multifactorial pathogenesis of the disease and its social consequences. In the course of the illness self-criticism and the capability of perceiving psychosocial factors increase. These results lead to the conclusion that the chronification of asthma bronchiale is a stimulus for confrontation with conflicts in the own biography and thus with the illness itself. It seems important to use different forms of psychotherapy depending on the duration of the illness.

[Psychotherapy in geriatrics]. / Psychotherapie in der Geriatrie.

Psychotherapy in geriatrics is a necessary and a rewarding task of the doctor. Some advice may be given here resulting from many years of experience with psychosomatic patients suffering from organic or functional diseases, consulting mostly general practitioners and internists. In hospital as well as in a general practice there are many possibilities of psychotherapy especially for the elderly and aged people. Diagnostic and therapeutic talks, conflict-centered, supportive therapy, autogenous training, depth-psychologically oriented individual and group therapy are important means of therapy in the old age. Other successful therapeutic procedures are behaviour therapy, family therapy and Guided Affective Imagery.

[Differentiation of colitis and Crohn disease patients based on psychosocial variables]. / Zur Differenzierung von Colitis- und Morbus Crohn-Kranken anhand psychosozialer Variablen.

Two groups of twenty-two patients each, one group suffering from morbus Crohn and the other from colitis ulcerosa, both groups receiving treatment in a medical institution, were compared on the basis of social data, standardized psychological testing techniques, experimental psychologic examinations, and data concerning their disorders. Generally there were hardly any differences between the patients in either group. Merely the results obtained in the experimental procedure differed slightly in that a more pronounced cognitive suppression of affects occurred with the colitis group. Furthermore, a stronger affinity to taking advantage of an offer for psychotherapeutic treatment could be observed in this group.

[Personality structure of patients with ulcerative colitis and Crohn disease, a psychological test study in disease remission]. / Zur Persönlichkeitsstruktur von Patienten mit Colitis ulcerosa und Morbus Crohn, eine testpsychologische Untersuchung während der Krankheitsremission.

30 patients with ulcerative colitis and 30 patients with Crohn's disease during remission were tested with the Freiburger Persönlichkeitsinventar (FPI) and standardized interview. There was no difference between both groups in the FPI, both were significantly less aggressive than controls. The patients with ulcerative colitis were more reserved and introverted, patients with Crohn's disease more self-confident, obliging and emotionally stable. Apart from two exceptions the answers in the standardized interview were similar in both groups. The patients with ulcerative colitis had a significantly better relationship with their mothers, the patients with Crohn's disease often called themselves "peacemaker". We couldn't confirm the clinical impression that there are important differences between patients with ulcerative colitis and Crohn's disease. A remarkable result, however, is that our study of patients during the remission didn't show any characteristics as nervousness, depression, emotional restraint and instability as it is described to be for the acute phase.

[Psychotherapy of Crohn disease]. / Zur Psychotherapie des M. Crohn.

Research and experience with 266 patients show that psychotherapy is an important element in the treatment of this disease, the etiology of which is still unknown. It widens the therapeutic possibilities of drugs, diet and operation. The different steps of psychotherapy combined with relaxation and removal of stress are described. The personality of the patient before the outbreak of the disease, his unknown conflicts may influence its course as well as the alteration caused by the disease itself, especially depression, mental lability and anorexia.

[Blood volume in aorto-femoral bypass operation. Effects of continuous thoracic epidural-, halothane- or neuroleptanesthesia]. / Blutvolumen bei aortofemoralen Bypass-Operationen. Einfluss der kontinuierlichen thorakalen Epiduralanaesthesie, Halothannarkose und Neuroleptanaesthesie.

49 patients with obliterative arteriosclerotic disease of aortic or iliac artery were tested with three different types of anaesthesia, epidural, halothane, and neuroleptanaesthesia. A normal blood volume was found preoperatively in these patients, i.e. of 75.8 +/- 14.9 ml/kg weight. Connections between blood volume and age or factors of risk were not traced. A patient with a-v fistula showed an obvious increased blood volume (120.2 ml/kg). Intraoperatively the blood volume varied widely during the different types of anaesthesia: while the blood volume increased in epidural anaesthesia (+17%) and remained unchanged by halothane (+1%), it decreased at the same volume load during neuroleptanaesthesia (-17%). A clear connection between changes of cardiac output and changes of the filling potential of the heart (cvp x bv) was found during epidural anaesthesia (r = 0.93). There was no functional connection in the neurolept group (r = -0.08). With halothane changes of filling potential correlated negatively with changes in cardiac output (r = 0.72). A connection between changes of the blood volume and the central venous pressure is evident only in the epidural group (r = 0.59). At the same time these reactions are dependent on the extent of the individual alterations of the vegetative tonus by the epidural block. Those individual changes are even more evident under halothane (r = 0.32) and especially neuroleptanaesthesia (r = 0.28). Therefore we question the control of blood volume by measurement of the central venous pressure for these patients.