Altruistic nondirected kidney donation: attitudes, characteristics and ethical implications.

PURPOSE OF REVIEW: Altruistic nondirected kidney donation involves a person donating one of their kidneys to an unknown recipient. The donor's mental health and motives are frequently questioned. We want to highlight this topic and also encourage discussions about ethical implications. RECENT FINDINGS: The main topics are the mental health of altruistic nondirected kidney donors and the general attitude towards the practice of this form of donation as well as the willingness of the public to donate this way. Soliciting organ donation via social networks or financial support is debated extensively in the media. SUMMARY: There is a lack of studies on altruistic nondirected kidney donation. Most studies focus on related donors. Studies with larger samples should be performed on altruistic nondirected kidney donors to learn more about their motives and assess their mental health.

[Psychodynamically oriented inpatient psychotherapy of depressive disorders - First findings from a naturalistic, multicenter study]. / Stationäre tiefenpsychologisch orientierte Psychotherapie bei depressiven Störungen (STOP-D) - Erste Befunde einer naturalistischen, multizentrischen Wirksamkeitsstudie.

OBJECTIVES: While the general effectiveness of psychodynamic psychotherapy in both outpatient and inpatient treatment has been proven, few studies document the effectiveness of clinical inpatient treatment of depression through psychodynamic psychotherapy. METHODS: This paper presents first results of a naturalistic multicenter intervention study. Included were female inpatients suffering from depressive symptoms who had been admitted to 15 psychodynamically oriented psychosomatic hospital units (N = 487). The mean duration of treatment was 61.8 days. Data were acquired at admission (T1) and discharge (T2). RESULTS: Our findings support previous evidence and show that psychodynamically oriented inpatient psychotherapy of depressive disorders is efficient. High pre-post effect sizes were documented in all psychometric instruments used (BDI, HAM-D, SCL-90-R, BSS, GAF). Initial subgroup comparisons reveal that the benefits for patients with comorbid personality disorder are significantly lower than for depressed patients without comorbid personality disorder. CONCLUSION: Psychodynamic inpatient psychotherapy, as practiced under naturalistic conditions, is an effective treatment of depression. Predictors of therapeutic effects within different therapeutic settings, however, remain unclear. The sustainability of the therapeutic effects found and their impact on psychodynamic relevant constructs have still to be proven.

Independency of myocardial stunning of endothelial stunning?

BACKGROUND AND OBJECTIVE: Vascular endothelial cells play an important role in the control of vascular tone. The reasons for coronary endothelial dysfunction are complex and may involve ischemia/reperfusion injury. We investigated whether endothelial, smooth muscle, and myocardial dysfunction are independent phenomena. METHODS: Rabbit hearts were rapidly excised without intermittent ischemia, connected to a modified Langendorff apparatus, and perfused with a modified Krebs-Henseleit solution containing bovine erythrocytes. Normoxic control hearts (n = 16) were perfused for 125 min. Postischemic hearts (n = 15) were perfused for 45 min, submitted to global ischemia (20 min) and reperfused (60 min). Both the normoxic and the postischemic hearts were divided into three groups that received either 0.9% NaCl (placebo), or 3-morpholinosydnonimine (SIN-1; 100 microM),or substance P (SP; 5 nM). RESULTS: After SIN-1, CBF in the normoxic hearts was increased by maximum 63% and after SP by 62%. 60 min after the onset of reperfusion, the postischemic hearts of both groups had recovered to 95% LVP(max). In the postischemic hearts, SIN-1 increased CBF still by 58%, while the endothelium-dependent vasomotion was impaired: SP improved CBF by only 9%. SUMMARY AND CONCLUSIONS: The particular protocol permitted differentiation between myocardial and vascular stunning. The results show that, while myocardial function has already recovered, endothelial cells are more severely impaired than smooth muscle cells, and that this injury persists beyond myocardial stunning. Thus, endothelial-dependent dysfunction can still impair vasodilatation while ventricular dysfunction has already resolved.

Psychosocial and personality predictors of tinnitus-related distress.

We set out to determine predisposing psychosocial and personality factors of experienced distress in chronic, decompensating tinnitus by a prospective investigation of 48 patients at two points: within 4 weeks of first tinnitus symptoms, and 6 months later, by sociodemographic, otological and psychological findings in a test battery [Symptom Checklist-90-Revised, Freiburger Persönlichkeitsinventar, Tinnitus Questionnaire]. Data were processed by multiple regression analysis. Forty-four patients (92%) returned complete data sets. Thirty-four patients displayed chronic tinnitus. The factors sleeping disturbance attributed to tinnitus, anxiousness and satisfaction with own life, each at the time of the first investigation, could explain 56% of variance of tinnitus distress at the time of the second investigation. Our results suggest that patients with psychological disturbances and sleeping difficulties at first presentation shortly after the onset of tinnitus have a higher risk of developing tinnitus-related distress. We suggest that our results support the fact that early psychosocial intervention in patients at risk may prevent development of chronic tinnitus with high psychological distress.

[How do patients experience their body after simultaneous pancreas-kidney transplantation? ]. / Wie reden Patienten nach einer simultanen Pankreas-Nieren-Transplantation über ihren Körper?

UNLABELLED: Simultaneous transplantation of pancreas and kidney (SPK) has become a standard procedure for type 1 diabetics with terminal kidney failure. Patients often experience SPK as a dramatic event which mobilizes a complexity of affects such as anxiety, hope, and gratitude. Patients often have fantasies regarding their bodies after transplantation which are linked to massive affects. METHODS: We investigated 8 non-selected patients in the first year after SPK by narrative interviews to study their experiences of transplantation. The interviews were audiotaped, transcribed and analysed according to Grounded Theory and ideal type analysis. RESULTS: Our patients had many different private theories and fantasies regarding transplantation. Patients' experiences were centred around themes of adoption of the transplanted organs and the protection of identity and self, and could be grouped into five ideal type sets. CONCLUSIONS: Bodily fantasies of our patients can be interpreted as specific adaptations to coping requirements after transplantation.

Qualitative psychotherapy research in German-speaking countries.

The authors present an overview of qualitative psychotherapy research in German-speaking countries. Special attention is paid to specific characteristics of methods, topics, and results, about which little is known in English-speaking countries. The authors describe historical and sociological developments in psychiatry, psychosomatic medicine, clinical psychology, and the social sciences relevant to the advancement of qualitative psychotherapy research. They then focus on the development of methods of analyzing and generalizing data obtained from qualitative observations. Finally, they outline the most important topics and results of these methods: first interviews with patients/diagnostics, psychosomatic syndromes, patient's experience of the therapy process, interaction between patient and therapist, therapist's experience of the therapy process, and follow-up research.