Stigmatization experience, coping and sense of coherence in vitiligo patients.

OBJECTIVE: This study examines the extent of stigmatization experienced by vitiligo patients considering the visibility of the lesions. METHODS: 363 vitiligo patients were assessed using the Experience with Skin Complaints (QES), Adjustment to Chronic Skin Disorders (ASC), and Sense of Coherence (SOC) questionnaires. Out of the total patients group two representative samples with 52 patients each were identified comparable for age, gender, and the duration of the skin disease, the first with visible and the second with invisible lesions. RESULTS: Data indicate a significant negative correlation between the QES dimensions, except for 'Composure', and between coping scales with sense of coherence withstanding. The 'visible lesions' group scored higher compared to the 'invisible lesions' group on the two QES scales 'Self-Esteem' and 'Refusal', i.e., patients with visible lesions experienced a higher level of stigmatization. CONCLUSION: This study provides new information which supports the notion that the stigmatization experience of vitiligo patients is psychologically relevant.

[Quality of life and exercise capacity in lung transplant recipients]. / Lebensqualität und körperliche Leistungsfähigkeit bei Patienten nach Lungentransplantation.

BACKGROUND: Quality of life in lung transplant recipients (LTR) is reported to be comparable with that of the general population. However, previous studies have shown that exercise capacity was reduced to 30 - 40 % of normal values. The purpose of this study was to investigate the gap between good self-reported quality of life and reduced exercise capacity in LTR, to describe possible correlations and to compare the results with those of a control group (CG). METHODS: 27 LTR 208 +/- 67 days after bilateral lund transplantation (16 male, 11 female; age: 46 +/- 10 years; body mass index: 24 +/- 3 kg x m (- 2), FEV (1) % 75 +/- 27 %) and 30 controls (17 male 13 female; age 47 +/- 15 years; BMI: 26 +/- 4 kg x m (- 2), FEV (1) % 103 +/- 15 %) performed cardiopulmonary exercise testing and were interviewed with the standardized German "Quality of life profile for chronic disease" self-rating questionnaire. RESULTS: Significant differences were shown in objective exercise related variables (peak oxygen consumption: LTR 15.1 +/- 1.8, CG 34.5 +/- 9.1 ml x min (- 1) x kg (- 1); p < 0,01); peak workload: LTR 1.0 +/- 0.2; CG 2.4 +/- 1.0 W. kg (- 1); p < 0.01); percentage of predicted workload: LTR 44 +/- 12, CG 115 +/- 33 %; p < 0.01). The rating of subjective quality of life in physical, psychological and social domains of LTR did not differ from values of the CG or of the general population (n = 1143). The quality of life in the physical domain correlated significantly with peak exercise capacity (LTR r = 0.44, p < 0.05; CG r = 0.37; p < 0.05). CONCLUSION: Patients 7 months after lung transplantation described their physical, social and psychological quality of life as equally good as the healthy control group. However, peak exercise capacity and oxygen consumption were markedly reduced. To improve physical capacity in the range of daily activities, an exercise training program should be offered to patients after lung transplantation.

[Phase III rehabilitation after heart transplantation]. / Phase III Rehabilitation nach Herztransplantation. Effekte auf Lebensqualität, Leistungsfähigkeit und kardiovaskuläre Risikofaktoren.

INTRODUCTION: Longterm treatment after heart transplantation (HTX) improves survival, although the quality of life and exercise tolerance decreased continuously between one and ten years after transplantation. The role of physical exercise and psychological support in longterm treatment after HTX has not been determined. We analyzed the effects of a one year outpatient rehabilitation program in combination with a home based, computer assisted training program on exercise capacity, coronary risk factors and quality of life. METHODS: 20 heart transplant recipients in an intervention group and 12 patients after HTX in a control group participated in the study (IG (CG); 5.1+/-2.2 (4.5+/-2.3) years after HTX; age: 55+/-7 (54+/-8) years; body mass index: 28.3+/-1.0 (28.7+/-0.9) kg.m(-2)). Before and after the intervention, maximum and constant load exercise capacity, and self-reported quality of life were evaluated. The 12 month intervention period included 10 days of exercise testing as well as medical and psychological support. Furthermore, the IG group performed a computer-assisted and controlled home ergometer training every second day. RESULTS: After one year with 114+/-18 exercise training sessions, maximum oxygen consumption increased in the IG from 18.8+/-4.2 to 20.1+/-4.2 ml.min(-1).kg(-1) (p<0.05; CG 19.3+/- 4.5 to 18.5+/-2.8 ml.min(- 1).kg(-1); p<0.01 IG vs CG). In the IG, lower back pain, body fat, and blood pressure were all reduced, while the self-reported quality of life, endurance exercise capacity and HDL cholesterol were increased. No significant changes occurred in the control group. CONCLUSIONS: When initiated years after heart transplantation, longterm rehabilitation reduced coronary risk factors and significantly improved both the subjects' quality of life, as well as a near to normal capacity for physical work.

[Stigmatization and quality of life of patients with psoriasis and atopic dermatitis]. / Stigmatisierungsgefühl und Lebensqualität bei Patienten mit Psoriasis und Neurodermitis.

BACKGROUND AND OBJECTIVE: Psoriasis and atopic dermatitis patients are often influenced by the psychosocial consequences of their skin diseases. In order to assess these experiences reliably, the stigmatization feeling and the quality of life of these patient groups were studied. PATIENTS/METHODS: The short form of the "Questionnaire on Experience with Skin Complaints" (QES) was validated in a sample of 463 in-patients with psoriasis and atopic dermatitis. In addition, the Dermatology Life Quality Index (DLQI) was ascertained. RESULTS: The dimensions "impairment of self-esteem and withdrawal", "rejection experienced", "concealment", and "composure" of the QES could be confirmed by factor analysis. As expected, middle high correlations between the QES and the DLQI were found in both patient groups. However, the stigmatization experience and the quality of life were not significantly different in a subgroup of psoriasis and atopic dermatitis patients with comparable sociodemographic characteristics. CONCLUSIONS: The short form of the QES with 23 items is a valid instrument for the examination of social and psychic burdens of psoriasis and atopic dermatitis patients. The recording of the stigmatization feeling and of the quality of life determines different, supplementary aspects of the illness-related stress of patients with chronic skin diseases.

Psychosocial adjustments 5 years after burn injury.

The present study investigates factors influencing the quality of life and social reintegration of burn victims. A study concept was developed to assess the functional and aesthetic long-term outcomes of burn victims. Objective data from a clinical examination was correlated with subjective data from completed questionnaires. The success of social rehabilitation was documented and an indicative profile of life quality evaluated. This profile could prompt early intervention if found necessary. Ninety-two patients were examined 5.4+/-1.1 years after trauma in relation to three factors: physical functions, localization of the burn injuries and extent of the body surface area burned. Physical functioning allows the best predictions for successful rehabilitation, because all areas of life quality are affected by it. Localization of burns in the face and hands creates disadvantages in social reintegration. Of less value in prediction is the extent of the body surface area burned, which is only closely linked to occupational rehabilitation and directly correlates to physical functional limitations. Our correlation showed, that even slight functional limitations were linked to severe depressions, similar to the values found with patients with serious functional impairment. Interdisciplinary cooperation between plastic surgeons and psychosomatic specialists will optimize early intervention with patients exposed to social maladaptation.

Non-specific effects of traditional Chinese acupuncture in osteoarthritis of the hip.

OBJECTIVES: The effectiveness of acupuncture treatment in patients with osteoarthritis of the hip was tested. DESIGN: This is a prospective, randomized, controlled, patient- and investigator-blinded clinical trial. PATIENTS AND SETTING: The study was performed at a university department for physical medicine and rehabilitation. Sixty-seven patients were separated into two treatment groups. INTERVENTIONS: Group 1 (treatment) had traditional needle placement and manipulation, whereas in group 2 (control) needles were placed away from classic positions and not manipulated. In both groups needles were placed within the L2 to L5 dermatomes. Outcome parameters were: pain (VAS), functional impairment (hip score), activity in daily life (ADL) and overall satisfaction before treatment, and 2 weeks and 2 months after treatment. RESULTS: For all parameters there was a significant improvement versus baseline in both groups 2 weeks and 2 months following treatment, but no significant difference between the two treatment groups. CONCLUSIONS: We conclude from these results that needle placement in the area of the affected hip is associated with improvement in the symptoms of osteoarthritis. It appears to be less important to follow the rules of traditional acupuncture techniques.

[Illness-related stress in psoriasis vulgaris. Validation of the "Psoriasis Daily Stress Inventory"]. / Krankheitsbezogener Stress bei der Psoriasis vulgaris. Validierung des "Psoriasis-Alltagsstress-Inventars" (PAI).

BACKGROUND AND OBJECTIVE: Illness specific stress plays an important part in the daily life of psoriatic patients. Until now for the measurement of relevant aspects of daily stress only the "Psoriasis Life Stress Inventory" (PLSI) of Gupta & Gupta exists; with the "Psoriasis-Alltagsstress-Inventar" (PAI), a German version of the PLSI is presented and its psychometric properties are discussed. PATIENTS/METHODS: 385 in-patients completed the PAI. The internal validity was examined by factor analysis. Moreover, the correlations between the PAI total score and sociodemographic parameters (ANOVA) and extent of skin involvement (multiple regression) were determined. RESULTS: The PLSI score proves to be sufficiently independent of age, sex, age at onset, and general extent of skin involvement. However, affections of the hands, the lower abdomen and the genitals show a strong influence on the total score. We found marked interrelations with the stigmatization feeling ("Questionnaire on Experience with Skin Complaints" QES, Schmid-Ott et al. 1998). CONCLUSIONS: The results suggest that the PAI is a useful and psychologically relevant questionnaire for psoriatic patients.

[Effect of needle acupuncture on pain perception and functional impairment of patients with coxarthrosis]. / Einfluss der Nadelakupunktur auf Schmerzwahrnehmung und Funktionseinschränkung bei Patienten mit Koxarthrose.

OBJECTIVES: The effectiveness of acupuncture treatment in patients with osteoarthritis of the hip was tested. DESIGN: This is a prospective, randomized, controlled patient and examiner blinded clinical trial. PATIENTS AND SETTING: The study was performed at a university department for physical medicine and rehabilitation. Sixty-seven patients were separated into two treatment groups. INTERVENTIONS: Group 1 (treatment) had traditional needle placement and manipulation, whereas in group 2 (control) needles were placed away from classic positions and not manipulated. In both groups needles were placed within the L2 to L5 dermatomes. Endpoints were pain (VAS), functional impairment (hip score), activity of daily living (ADL) and overall satisfaction before treatment, 2 weeks and 2 months post-intervention. RESULTS: For all endpoints there was a significant improvement in both groups 2 weeks and 2 months following treatment versus baseline, but no significant difference between the two treatment groups. CONCLUSIONS: We conclude from these results that needle placement in the area of the affected hip by itself improves symptoms of osteoarthritis. It appears to be less important to follow the rules of traditional acupuncture techniques.

[Results of a 1-year follow-up study of neighborhood ambulatory aftercare after inpatient psychosomatic rehabilitation]. / Ergebnisse der 1-Jahres-Katamnese einer ambulanten wohnortnahen Nachsorge nach stationärer Psychosomatischer Rehabilitation.

Attention has been repeatedly drawn to the necessity to support patients after psychosomatic rehabilitation with their transfer of skills acquired during their stay at the interface between their inpatient treatment and their reintegration into everyday life. The authors' concept of the outpatient aftercare was already introduced in an earlier paper. This article presents the results of the one-year follow-up. A comparison with a control group revealed a further reduction of patients' depression. In contrast to the control group, the reduction in fear and discomfort already achieved during inpatient rehabilitation remained stable. At the same time the ability to cope with everyday life was expanded. Compared with the control group the participants of the aftercare could reduce the absence from work, days spent in hospital and visits to the doctor more than twice as much. Methodological problems of the design of the study are critically discussed.

[Medical and non-medical ambulatory psychotherapy in the Hannover area. A specialty, school and sex related comparison]. / Arztliche und nichtärztliche ambulante psychotherapeutische Versorgung im Raum Hannover. Ein fach-, schulen- und geschlechtsbezogener Vergleich.

The result of an investigation of 128 from 283 (45.2%) medical and psychological psychotherapists established in the city of Hannover is presented. The aim of the study is to characterize the situation of psychotherapeutical care not only by the number of psychotherapists in relation to inhabitants but also by the working time spent for psychotherapy. Besides we found gender, school of psychotherapy and professional experience as factor influencing the patients waiting time for beginning a psychotherapy. In contrast to other studies, the number of medical and psychological psychotherapists is not different, nevertheless the psychotherapeutical care in Hannover is not ensured.

[Illness experience and treatment seeking behavior of psoriasis patients]. / Krankheitserleben und Therapieinanspruchnahmeverhalten bei Psoriasispatienten.

We analyzed how psoriasis patients sought professional help and correlated it to their illness attitudes and feeling of stigmatization. Semi-structured interviews of 400 patients were reanalyzed to identify homogeneous groups concerning initial reactions at first manifestations of the disease. Four groups ("isolated", "stigmatized", "socially supported" and "non-stigmatized" patients) were found and cross-tabulated with five resulting groups of a second cluster-analysis concerning the "style" of the seeking behaviour of professional and paraprofessional help and medical measures against the psoriasis ("multi-users", "arranged mini-users", "waiting-room patients", "optimists" and "self-therapists"). We were able to describe typical courses of illness behaviour depending on the initial reaction. The results are discussed with regard to the desirable identification of problematic patients within professional care units.

[Sense of coherence and psychosomatic treatment outcome. An empirical study of salutogenesis]. / Kohärenzgefühl und psychosomatischer Behandlungserfolg. Eine empirische Untersuchung zur Salutogenese.

According to Aaron Antonovsky's model of salutogenesis health protective resources by him conceptualised as "sense of coherence" (SOC) determine decisively the ability to recuperate. We investigate the relationship between treatment outcome and the sense of coherence measured by the SOC questionnaire at the beginning (n = 81), during the inpatient treatment phase and 6 month later (n = 70). For testing the psychometric qualities we obtained additional data from the outpatient department (n = 461). SOC-Score increased significantly during inpatient treatment. Outcome of treatment could not be predicted by the initial SOC, but we found a highly significant relation between an increase in the SOC value and a decrease in complaints (SCL-90-R, r = .81). In our opinion, the application of the SOC in psychosomatic patients is restricted, because there is a high overlap with psychic complaints (i.e. anxiety, depression).

[Patient-medical staff-consultant triad: conditions for satisfaction in psychosomatic consultation service]. / Die Patient-Stationsarzt-Konsiliarius-Triade: Bedingungen der Zufriedenheit im psychosotischen Konsiliardienst.

In a large 1000 bed University Medical Center the psychosomatic consultation service (PCS) was evaluated by a two step investigation. 1. Housemen (interns) and senior staff members were asked by questionnaires about their previous experiences with psychological medicine and particularly about their satisfaction with the PCS and how they would estimate the need for additional psychosomatic treatment for the patients on their ward. A striking disproportion was found between actual requests (1.8%) for PCS and the estimated need (18%) for additional psychosomatic advice or treatment. 2. Questionnaires dealing with satisfaction were given to the consultant, the patient and the consultee. The satisfaction of the consulte was mainly determined by the promptness in answering his request and formal aspects of the exchange, the patient satisfaction was mainly determined by the way they viewed the help, the sense of importance of the consultation and by the feeling of being understood by the consultant. This seems to influence the future compliance. Surprisingly, a correlation between the patient satisfaction with the consultation and the quantitative and qualitative aspects of exchange between consultant and consultee was less clearly demonstrated. This could be seen as a hint of communication problems between the consultee and his patient, the improvement of which is one of the main concerns of psychosomatic consultation.

Psychotherapy and bulimia nervosa: evaluation and long-term follow-up of two conflict-orientated treatment conditions.

Analytic in-patient therapy (n = 32) and systemic out-patient therapy (n = 39) were applied to patients with bulimia nervosa, and the effects were evaluated 14, 26 and 38 months after the start of the treatments. Our assumptions about the general efficacy of both conflict-orientated techniques were confirmed: both therapies satisfactorily reduced the symptomatic behaviour, as well as secondary factors related to bulimia nervosa, in the long term. However, we could not identify differential effects of the two treatment regimes, which we had expected with regard to the very different therapeutic approaches. The similarities of outcome of both therapies predominate, with slightly better results in the case of the analytic in-patient treatment. The results are discussed with regard to the assumption that specific healing factors are involved in conflict-orientated treatments in addition to the "common factors' of psychotherapy.

Everyday addictive behavior of bulimic women.

The comorbidity of bulimia nervosa and other forms of drug use or dependence is frequently reported, but statistical comparison as well as reference to a theoretical background is rare to be found. In order to assess the associated dependencies of bulimia, 105 bulimic women participated in a structured interview with a focus on their everyday drug use. Our results suggest that there is little evidence of other forms of related addicting drugs among bulimics. A possible theoretical background which explains the resulting pattern of their taking of stimulants and drugs is the common belief about desired effects of the consumption of these substances.

Therapy outcome of two treatment models for bulimia nervosa: preliminary results of a controlled study.

Beyond the reduction of the core symptoms, different modification patterns are expected due to differing emphases in two alternative types of treatment for bulimia nervosa: inpatient analytic and outpatient systemic therapy. The initial results of a study with a waiting-list control group are reported. Eating disorders of the bulimic women definitely improved in both therapy groups, the results for the inpatient group (n = 27) indicate a basic change in the attitude towards eating.

[Resistance behavior and symptoms after one year of inpatient psychosomatic therapy]. / Abwehrverhalten und Symptomatik ein Jahr nach stationärer psychosomatischer Therapie.

One year after analytic oriented group psychotherapy on our psychosomatic ward a questionnaire for measuring mechanisms of defence and a symptom list were given again to the initial sample. At follow-up a significant reduction was ascertained on the dimensions turning against self and projection, on the dimension turning against object the starting position was reached again, a significant increase was ascertained for principalization--or intellectualization. The more adequate coping with conflicts in parts was associated with a significant reduction of bodily and psychic complaints.

[Bulimia with and without a history of anorexia--variants or entities?]. / Bulimien mit und ohne Vorgeschichte einer Anorexie--Varianten oder Entitäten?

A group of bulimic women (n = 70) with (n = 23) and without (n = 47) a history of anorexia nervosa has been assessed concerning symptomatology, complaints and personality factors. Demographic variables were controlled for bias. As we had supposed, there was no difference for most of the variables analyzed. Some of the residual differences could be due to item formulation ("Oral Control"; EAT) or express the slight persisting underweight ("weight", "underweight") of the former anorexics. Nevertheless, this group unexpectedly seems to feel not equally disturbed concerning "Ineffectivity" (EDI), "Anancasm" (ANIS) and some personality factors ("Social Orientation", "Aggression", "Sorrows concerning health", "Neuroticism"; FPI-R). The similarity is even more impressive if the scores are seen in relation to population norms (Graph.). On demographic variables except weight both groups seem to be strikingly similar. The relative weight (or "underweight"), which was considered as a possible covariate, did not contribute significantly to most of the dimensions, so that the actual body shape cannot be viewed as significantly influencing personality and eating related factors. From the data analyzed we conclude that there are no reasons to consider bulimia with and without a former anorexia as distinct disorders.

[Change in conflict management in inpatient psychotherapy. A psychometric study of defense behavior]. / Anderung der Konfliktbewältigung während stationärer Psychotherapie. Eine psychometrische Untersuchung zum Abwehrverhalten.

A recently developed questionnaire for measuring various mechanisms of defence was given to a consecutive sample of 54 patients at the beginning and the end of their psychotherapy on our psychosomatic ward. A significant reduction was ascertained on the dimensions principalization--or intellectualization--and turning against self, a significant increase on the dimension turning against object. The results of this assessment can be interpreted in the sense of a more adequate coping with conflicts which has to be proved by further investigations.