[Standardized enteroclysis. Monitoring of intra-lumen pressure in 3 different patient groups]. / Standardisierte Enteroklyse. Registrierung des intraluminalen Drucks in drei unterschiedlichen Patientenkollektiven.

PURPOSE: Monitoring of intraluminal pressure in standardized enteroclysis. MATERIAL AND METHODS: Pressure monitoring with a double-lumen tube during fluoroscopy-guided adjustment of contrast media instillation rate due to small bowel motility and contrast media transport of 67 patients. Stratification according to patient data and findings in enteroclysis: Crohn's disease (n = 12), non-inflammatory disease (n = 35) and irritable bowel syndrome (n = 20). RESULTS: The amount, instillation period and rate of contrast media and distension media were not statistically different within the study population. Crohn's disease patients showed elevated intraluminal pressure at the end of the distension phase (47.94 +/- 10.42 cm H2O versus 38.03 +/- 10.08 and 39.55 +/- 9.74 cm H2O, respectively, P = 0.0099), as well as at the end of the examination (48.59 +/- 10.42 cm H2O versus 39.66 +/- 6.52 and 35.67 +/- 8.28 cm H2O, P = 0.0002). In comparison with both other patient groups, maximum intraluminal pressure in Crohn's disease is higher and totals 51.75 +/- 9.94 cm H2O versus 43.00 +/- 6.20 and 39.55 +/- 9.74 cm H2O, P = 0.0010. Patients with Crohn's disease require a longer instillation period of distension media (28.05 +/- 12.82 min, not statistically significant). CONCLUSION: Intraluminal pressure differs in standardized enteroclysis with fluoroscopy-guided instillation rate adjustment. Irrespective of stenosis or acute inflammation, patients with Crohn's disease show a higher intraluminal pressure compared to patients with non-inflammatory disease or irritable bowel syndrome.

[Structured day care therapy program for eating disorders]. / Strukturiertes tagklinisches Therapie-Programm für Essstörungen.

A day hospital group treatment program is detailed which could offer effective treatment to many patients with anorexia nervosa and bulimia nervosa who would otherwise require inpatient treatment. Important clinical advantages over an inpatient program are described. The psychotherapy is cognitive-behavioral oriented and is done in groups. A multi-disciplinary team approach is used. The day hospital treatment program includes psychological, social and eating-related interventions. Main characteristics are the motivation-phase, the contact between patients of different therapy-phases, the involvement of families in therapy and the support of self-help. First empirical outcome results are presented.

[Experiences of schizophrenic patients in ambulatory care with oral neuroleptics--baseline for psychoeducational interventions]. / Erfahrungen ambulanter schizophrener Patienten mit oralen Neuroleptika--Befundbasis für psychoedukative Interventionen.

In the run-up to a prospective intervention study to assist the preparation of psychoeducational therapeutic measures, schizophrenic out-patients were questioned on their experiences with two oral neuroleptics, Clozapine and Perazine. The two drugs, which are known to have similar side effects, find equal acceptance among patients. Subjective attitudes to medication and general evaluations of drug therapy are extremely positive. Numerous patients had already modified their neuroleptic dosage on their own initiative, in most cases discontinuing their medication but in some cases increasing or reducing the dose. These experiences can be used in designing a psychoeducational intervention directed towards individual needs.

[Social support, disability, coping with stress and personality markers in patients with subjective chronic aural tinnitus and a clinical control group]. / Soziale Unterstützung, Beschwerdedruck, Stressverarbeitung und Persönlichkeitsmerkmale bei Patienten mit subjektivem chronischem Tinnitus aurium und einer klinischen Kontrollgruppe.

The inhibition of physiological habituation in patients with chronic aural tinnitus extends from the level of cellular processing to psychologic and psychosocial determinants. The following hypotheses were tested in 32 patients with chronic tinnitus and 30 patients of a comparable clinical control group: tinnitus patients differ concerning (1) the perception of social support, (2) a disposition to psychosomatic diseases, (3) coping with stress and (4) certain personality traits. Standard psychological tests were used as well as a detailed examination of at least 30 minutes. Results showed that the tinnitus patients statistically perceived less social support and more social distress compared to the control group. They also showed significantly poorer results in coping with stress. Increased social distress in a number of cases resulted in noticeable decompensation. Additionally, a disposition to psychosomatic disorders increased, so that conflicts arising expressed themselves in various functional diseases. In most cases psychiatric exploration showed a vocational or familial overcharge. In patients experiencing decompensation, close cooperation with a psychotherapist is required.

[Can psycho-education of chronic schizophrenic patients have a short-term effect on drug-related attitude and behavior?]. / Kann Psychoedukation bei chronisch schizophrenen Patienten kurzfristig medikationsbezogene Einstellungen und Verhaltensweisen beeinflussen?

Within a controlled intervention study with schizophrenic outpatients we investigated the question of whether regular attendance at psychoeducational training for medication management has an influence on patients' illness-related behavior. The patients in the treatment group show better outcome of compliance and some treatment-related attitudes, though without statistical significance. Despite extensive information they are no more content with their knowledge of drugs than the control group, but more aware of problems, i.e. more cautious in medication co-determination.

Expressed emotion in depressed patients and their partners.

This study was designed to assess the expressed emotion (EE) status in the spouses of depressed patients and the patients themselves, to relate the EE status to the severity of depression as measured by the Beck Depression Inventory (BDI), and to compare the prevalence of high EE between the target and control group. Seventeen depressed patients and their spouses, and 20 control couples participated in the study. The Five-Minute Speech Sample was used to assess the EE status. High EE was significantly more common in spouses of depressed patients and the patients themselves than in controls. There was a significant relationship between the EE status of the patients and their spouses. High EE in the patient and in the spouse corresponded significantly with a high BDI score of the patient. These findings underline the importance that in EE research the patients' EE status as well as their present mental health state must also be taken into account.

Pressure sensitivity in bulimic women: a contribution to research in body image distortion.

The present study is a first step towards specifying perceptual peculiarities rather than visual ones that may contribute to a distorted body boundary experience in women meeting DSM III criteria for a diagnosis of bulimia. Fourteen bulimic women and 14 women without bulimia but closely matched in age, height and weight participated in the study. Pressure sensitivity was measured by means of the von Frey method under three conditions: (1) at the tip of the right index finger, (2) at the lower abdomen, (3) at the lower abdomen again, but with financial reward promised for high performance. Data confirmed the hypothesis that at both sites pressure sensitivity thresholds would be significantly higher for the bulimic group than for the comparison group. It is possible that deficits in pressure sensitivity are related to overestimation of the width of the respective body parts.

Distorted body image in bulimic women.

Fifteen bulimic women (DSM III) and 15 women with no indication of an eating disorder, matched pairwise with respect to age, weight and height, were assessed via a distorting video image technique under four conditions. They were asked to: (1) estimate the width of a water bottle, (2) estimate the width of their own body, (3) repeat those estimates under a condition of reward for high accuracy, (4) focus attention on their bodily sensations and indicate how wide their body felt. While groups did not differ in their estimates under condition 1 (water bottle), significant differences were found between groups under conditions 2, 3 and 4 (own body), the percentage of overestimating being highest when subjects were to indicate how wide their body felt. Results suggest that modalities of perception other than visual are strongly involved in the body image distortion of bulimics.

Expression of emotion in asthmatic children and their mothers.

The present study assessed how general asthmatic children's deficit in the facial expression of emotion is that we found in previous studies. Furthermore, the emotional behavior of the patients' mothers was explored. Eighteen children with bronchial asthma (ages 7.6 to 12.6), and eighteen control children were subjected to two frustrating achievement situations. They had to solve a difficult puzzle under time pressure by themselves, and with the verbal assistance of their healthy mothers. Facial expressions of emotion and heart rate were recorded from children and mothers. No deficit in emotion expression was observed in the asthmatic group. To the contrary, asthmatic children showed more expressions of anger/aggression and emotion expressions in total during the last phase of the 'child alone' condition. Moreover, in both experimental conditions they showed more unspecified facial movements than control children. Mothers of asthmatic children expressed more happiness than their controls. Heart rate data did not differentiate between target and control groups during any phase of the experiment. These findings counter psychodynamically based assumptions on emotional behavior of asthmatics and their mothers.

[Surgical risk in plasmacytoma]. / Das Operationsrisiko beim Plasmocytom.

An increase in postoperative complications (37%) and lethality (24%) has been found in 15 of our patients and 102 mentioned in the literature, all suffering from plasmocytoma. Pathological paraproteins are responsible for disturbances in coagulation, immune system, and renal function. Possibilities of reducing the operative risk are discussed.