Relationship between anger and pruritus perception in patients with chronic idiopathic urticaria and psoriasis.

BACKGROUND: There is evidence that chronic idiopathic urticaria (CIU) and psoriasis are associated with personality based difficulties in emotional regulation particularly with regard to the feeling of anger. This deficit in emotional awareness could lead to the phenomenon that emotions are rather experienced in bodily symptoms such as pruritus. AIM: We investigated whether there is a relationship between pruritus as major symptoms in CIU and psoriasis and the experience of negative emotions. SETTING: Forty-one CIU patients and 44 psoriasis patients treated at Bonn University Hospital and 49 healthy controls were included. METHOD: Patients and controls were compared on questionnaires measuring alexithymia (TAS-20), emotional distress (SCL-90-R) and anger (STAXI). In skin-disordered patients, separate stepwise regressions with pruritus severity as dependent variable and questionnaires, skin status, duration, sex and age as independent variables were calculated. RESULTS: CIU and psoriasis patients showed higher alexithymia, emotional distress, depression, anxiety and state anger compared with controls. State anger was the only significant predictor of pruritus severity in CIU explaining 19% of variance. Depression was the only significant predictor of pruritus severity in psoriasis explaining 12% of variance. CONCLUSIONS: Our findings suggest a relationship between pruritus severity and anger in CIU. Furthermore, our results indicate a relationship between pruritus severity and depression in psoriasis.

Social and health adjustment of bulimic women 7-9 years following therapy.

OBJECTIVE: To examine the long-term social adaptation and long-term follow-up of bulimic women after therapy. METHOD: Eighty women with bulimia nervosa were investigated 7-9 years after the beginning of either conflict-oriented in-patient therapy or systemic out-patient therapy. Data was gathered through interviews and patient questionnaires. RESULTS: At the time of follow-up, 28.9% still had DSM-III-R bulimia, 10.1% suffered from subthreshold bulimia or anorexia (EDNOS), 61.2% did not suffer from any DSM-III-R eating disorder. Compared with statistics on the normal population, the social adaptation of the women was quite good with regard to work, household and living conditions. Some dimensions representing probable aetiological factors (i.e. restrictions of intake, feelings of ineffectiveness) showed a delayed reaction to therapy. CONCLUSION: Long-term outcome of bulimia nervosa may be expected to be moderately good. During therapy, greater attention should be paid to characteristics of the disorder less responsive to treatment.

Lipoprotein metabolism in patients with anorexia nervosa: a case-control study investigating the mechanisms leading to hypercholesterolaemia.

Hypercholesterolaemia is a common finding in patients with anorexia nervosa (AN). To investigate the type, frequency and pathophysiological mechanisms of changes in lipoprotein metabolism in AN we performed a cross-sectional study in fifty-eight female patients (mean age 24.2 years, BMI 15.3 (sd 1.5) kg/m(2)) and fifty-eight healthy age-matched controls (CO; BMI 22.2 (sd 1.7) kg/m(2)). Total cholesterol and LDL-cholesterol were higher in AN (5.5 (sd 1.3) v. 5.0 (sd 0.8) mmol/l, P=0.023; 3.6 (sd 1.1) v. 3.2 (sd 0.7) mmol/l, P=0.025 respectively). LDL particles were significantly more enriched in cholesterol and triacylglycerol in AN. In multiple regression analysis with LDL-cholesterol as the dependent and BMI, total body fat ( %), lathosterol:cholesterol ratio (endogenous cholesterol synthesis), 7alpha-hydroxy-4-cholesten-3-one (bile acid synthesis), non-esterified glycerol, free triiodothyronine and free thyroxine as independent variables, BMI was the only significant predictor in CO (R(2) 0.36, overall P=0.001). In AN the variability of LDL-cholesterol was significantly predicted by total body fat, free thyroxine, BMI, free triiodothyronine and non-esterified glycerol (R(2) 0.55, overall P<0.001). Subgroup analysis between restricting (AN-R) and binge-eating-purging patients (AN-B) indicated that in AN-R changes in lipoproteins, BMI and total body fat were more pronounced. AN-R patients had lower bile acid synthesis than AN-B (P=0.02). We conclude that elevated cholesterol concentrations in AN are generally due to an increase in LDL-cholesterol, which is mostly determined by the severe loss of body fat and the resulting changes in thyroid hormones, increased lipolysis and decreased endogenous cholesterol synthesis with resulting decrease in LDL removal. The clinical subtype of AN plays a major role in the mechanisms leading to hypercholesterolaemia.

The application of body cell mass index for studying muscle mass changes in health and disease conditions.

Body mass index (BMI) fails to detect altered nutritional state in the presence of overweight or obesity, since malnutrition can be present and masked by the abnormal amount of fat mass. Measuring body cell mass (BCM) contents for the evaluation of muscle mass and protein tissue states is well accepted. The aim of the present study was to apply body cell mass index (BCMI) to monitor the muscular mass changes of male and female Olympic athletes, renal dialysis patients, and anorexia nervosa patients in comparison with healthy subjects. The BCMI values of male subjects from the healthy group and Olympic athletes groups, but not the renal dialysis group, were significantly higher ( p<0.0001) than those of female subjects from the same groups. In addition, subjects with normal or high BMI values may be malnourished as highlighted by a low BCMI. We believe the BCMI is more sensitive than the BMI for studying the nutritional status of the individual.

[Somatization and alexithymia in male infertility. A replication study]. / Alexithymie und Somatisierung bei infertilen Männern. Eine Replikationsstudie.

BACKGROUND AND OBJECTIVE: In a previous study, we found a higher degree of alexithymia and somatization in infertile men (Hum Reprod 2001 Vol.16(3),587-592). This study was designed to confirm the findings of the former study PATIENTS/METHODS: 88 infertile men (48 idiopathic infertility, 40 somatic infertility) were consecutively enrolled in the study. The control group consisted of 44 healthy men. Alexithymia was measured by the 20-item-Toronto-Alexithymia-Scale;somatization was measured by the Symptom Checklist-90-R. RESULTS: There were no differences between the subgroups of infertile men. The study group showed a significantly higher sum score in the TAS-20 (p<0.01) and a higher score on the scale somatization in the Symptom Checklist-90-R (p<0.05) compared to the control group. CONCLUSIONS: Our study replicated the findings of the previous investigation. Alexithymia and somatization are discussed as consequences of coping with male infertility.

Impact of the turning-against-self defense mechanism on the process and outcome of inpatient psychotherapy.

The authors examined the relation between specific defense mechanisms and treatment process and outcome in psychodynamic psychotherapy. Three measures, Questionnaire for Conflict Coping Strategies, Questionnaire on the Experience of the Inpatient Therapeutic Process, and Symptom Checklist-90-R, were given to 65 inpatients of a psychosomatic clinic, predominantly with depressive or eating disorders. Turning against self was the most frequently used defense mechanism in the patient group. A high level of turning against self that could be reduced significantly during treatment was associated with good adaptation to treatment setting and positive treatment outcome defined by symptom distress reduction. Assessment of defense mechanisms and their interaction with therapeutic factors in the therapy setting can be useful to better understand the treatment process and the subsequent development of specific interventions to enhance treatment outcome.

Relationships between personality traits, seminal parameters and hormones in male infertility.

In this study we investigated the relationship between personality attitudes, psychopathological symptoms and biological parameters in male infertility. Eighty-four infertile men underwent a psychological and medical examination at our clinic. The psychological tests comprised the Symptom Checklist 90-R, the Toronto Alexithymia Scale and the NEO-Five Factor Inventory. Seminal parameters, gonadotrophins, sex steroids, cortisol and prolactin were analyzed to obtain biological data. Compared with questionnaires completed by normal populations those in the study group scored higher on the scales for 'conscientiousness', 'agreeableness', 'alexithymia' and 'somatization' and lower on the scale for 'neuroticism'. Regarding psychobiological correlations we found a negative correlation between seminal parameters and 'extraversion', 'anxiety' and 'psychoticism'. 'Alexithymia' was negatively correlated with stress hormones and 'conscientiousness' was correlated with sex steroids. The findings suggest above average social competence in the study group. The psychobiological correlations indicate a link between social-competence-related personality traits such as 'extraversion' and 'conscientiousness' and biological fertility characteristics. Implications of a higher alexithymia in infertile men, which is negatively correlated with stress hormones, are discussed.

[Evaluation of therapeutic success by patients with anxiety disorders after inpatient psychotherapy]. / Bewertung des Therapieerfolgs durch Patienten mit Angststörungen nach stationärer Psychotherapie.

OBJECTIVE: To identify factors influencing the subjective assessment of patients regarding the outcome of in-patient psychotherapy for anxiety disorders. METHODS: A total of 231 patients were tested at admission, discharge and 1-year follow-up in a multi-center study. Subjective outcome assessment was measured with the revised German version of the Helping Alliance Questionnaire. The use of the term "outcome satisfaction" is discussed. RESULTS: Patient outcome assessment did not correlate with age, sex, or education, or with duration or severity of illness or duration of treatment. Outcome assessment was closely connected with therapy success. Reaching a low symptom level ("clinical significance") had a higher impact than a high pre-post-difference ("statistical significance"). CONCLUSIONS: Anxiety patients give a generally positive assessment of their therapy outcome, which is most determined by symptom-related treatment success. The differentiation of "clinical" and "statistical significance" of success is of importance for the patient's subjective view of the therapy outcome.

[Differences between patients classified as "recovered" or "improved" and "unchanged" or "deteriorated" in a psychotherapy outcome study]. / Zur Unterscheidung von "geheilten" und "gebesserten" sowie von "unveränderten" und "verschlechterten" Patienten in einer Therapieerfolgsstudie.

The concepts of statistical and clinical significance of pre-post-changes have been used to class patients into four groups of therapy outcome: "recovered", "improved", "unchanged" and "deteriorated". Aim of this study is to investigate the advantages of this classification in comparison to a simple division into "successful" and "not successful". 43 patients were examined before and after an in-patient psychotherapy and again two years later with several test inventories. Therapy outcome was measured by the changes in the Global Severity Index of the SCL-90-R. "Recovered" and "improved" patients did only differ in regard to their initial symptom severity, but not in regard to the amount of symptom reduction or stability of therapy effect. "Deteriorated" patients could reduce their increase in symptoms until follow-up. Our results do not indicate a general advantage of the classification into four outcome groups over a division into "successful" / "not successful".

Magnetic resonance spectroscopic and relaxometric determination of bone marrow changes in anorexia nervosa.

OBJECTIVE: The objective of this study was to assess and quantify bone marrow changes in patients with anorexia nervosa using 1H magnetic resonance spectroscopy and relaxometry. METHODS: The bone marrow fat fraction and the longitudinal and transverse relaxation times (T1 and T2, respectively) of water were measured in the lumbar and femoral marrow of 20 patients with anorexia nervosa and 19 healthy control subjects. RESULTS: Patients with anorexia nervosa showed significant hyperhydration and reduction of the fat fraction in their bone marrow, predominantly in the proximal femur. These changes were associated with hematological abnormalities. In a retest of seven patients after psychotherapy and gain of weight, the pathological changes in marrow proved to be largely reversible in correlation with the increase in body mass index. CONCLUSIONS: Fat depletion and excess of tissue water in the bone marrow in anorexia nervosa can be quantified by 1H magnetic resonance spectroscopy and relaxometry. The distribution of the pathological changes in the lumbar and femoral marrow follows the pattern of normal bone marrow conversion from hematopoietic to cellular during childhood.

[Sexual satisfaction of women--development and results of a questionnaire]. / Sexuelle Zufriedenheit von Frauen--Entwicklung und Ergebnisse eines Fragebogens.

In sexology the existing questionnaires do not sufficiently consider the experiencing of sexuality and the extent of sexual satisfaction. That is why a questionnaire was developed which includes, besides the frequency and duration of sexual activities, the satisfaction with frequency and duration of these activities and the desired sexual behaviour. A first study with this questionnaire was carried out on 112 women with heterosexual behaviour, aged 20 to 48 years. The frequent desire with regard to coital orgasm as one result of our investigation confirms the centering of orgasm in other studies. But half of the women do not describe orgasm as the favoured feeling during sexual intercourse. For 37% of the women the emotional and physical closeness to the partner is explicitly more important than experiencing an orgasm. According to the comparison of extreme groups sexual satisfaction particularly correlates with self-determination realized in partnership and with satisfaction of communicational desires and need for tenderness within the partnership.

Alexithymia in male infertility.

The continuing confrontation with the thoughts and feelings surrounding an unfulfilled wish for a child makes coping very difficult. There is empirical evidence that, in medical illnesses associated with stress and loss of quality of life, patients react with alexithymia, which means a difficulty to communicate emotions. In this study we compared 84 infertile men with a group of 96 healthy men and 43 male psychosomatic outpatients concerning their ability to communicate feelings, measured by the Twenty-Item Toronto Alexithymia Scale and the amount of psychopathologically relevant symptoms, especially somatization, measured by the Symptom Checklist 90-R and a List of Complaints (Beschwerden-Liste). The results showed a significantly higher alexithymia in infertile men compared with healthy men (P < 0.05), but a significantly lower alexithymia compared with psychosomatic outpatients (P < 0.05). Furthermore the study group showed significantly more somatic complaints in the List of Complaints compared with healthy men (P < 0.05). The importance of alexithymia in male infertility is discussed on the basis of empirical results that it might play a defensive role as far as depression is concerned but on the other hand increases the possibility of somatic complaints. The need for prospective studies in further research is emphasized.

[Central serous chorioretinopathy and psychological stress]. / Chorioretinopathia centralis serosa und psychische Belastung.

BACKGROUND: To date we know little about the etiology of central serous chorioretinopathy. Former investigations discussed inadequate coping strategies and critical life-events as important psychological aspects. In this study we investigated the relationship between central serous chorioretinopathy and stress. MATERIALS AND METHODS: 35 male patients with central serous chorioretinopathy (group 1) were compared to 21 male patients with traumatic eye diseases. The evaluated data included sociodemographic data as well as data regarding the patients coping strategies, critical live-events before outbreak of the disease, personality factors and general physical complaints. RESULTS: Group 1 showed a significantly higher amount of general physical complaints, measured with a complaints questionnaire (B-L). In a personality inventory (FPI-R) it scored significantly higher on the scales emotional instability and strain, significantly lower on the scale extraversion. CONCLUSION: The results indicate that patients with central serous chorioretinopathy are more stressed because of inadequate coping strategies, which can be seen in a higher amount of physical complaints.

[Unresolved couple conflicts in male infertility]. / Ungelöste Paarkonflikte bei männlicher Infertilität.

BACKGROUND AND OBJECTIVE: There is empirical evidence that sterility causes a considerable amount of distress and affects correspondingly the partnership. Empirical results concerning male infertility show increased somatic complaints and reduced self-esteem of the men as well as a dominance of the accompanying partners. Which couple conflicts arise after the diagnosis of male infertility? PATIENTS/METHODS: 84 infertile men were examined with a partnership diagnostic questionnaire. The questionnaire was evaluated with regard to quantity and quality of unsolved couple conflicts. RESULTS: The results show that infertile men do not mention more unsolved conflict areas in their partnership than healthy men. If one looks qualitatively at the mentioned conflict areas, striking differences in comparison to the control group can be seen. CONCLUSIONS: In comparison to the control group of healthy men, the specificity of conflict areas in infertile couples can be best understood on the basis of exchange-theoretical considerations.

[Differences in 2 diagnostic groups of psychosomatic patients on the Symptom Checklist 90-R (SCL-90-R). Consequences for using SCL-90-R in follow-up research]. / Unterschiede zwischen Diagnosegruppen psychosomatischer Patienten in der Symptom-Checklist-90-R (SCL-90-R). Konsequenzen für den Gebrauch der SCL-90-R in der Verlaufsforschung.

680 unselected outpatients of our Psychosomatic Clinic were divided into six diagnostic groups and examined by the SCL-90-R. By ANOVA we found differences of means between the diagnostic groups for the global severity score (GSI) and for the subscale scores. We describe the model of Jacobson et al. [1,2] for the determination of cut-off-points and reliable change indices for the assessment of changes over time, e.g. after psychotherapy. Our results lead to the conclusion that, although an overall reliable change index for the GSI can be applied to all psychosomatic patients, cut-off-points should be different following the diagnostic groups. Furthermore, information from the SCL-90-R-subscales as well as other specific symptom scales should be used for the interpretation of significant changes of the GSI.

Renal function following combination chemotherapy with ifosfamide and cisplatin in patients with osteogenic sarcoma.

BACKGROUND: Ifosfamide and cisplatin are active agents that are currently used in the treatment of osteosarcoma. Nephrotoxicity has been reported following their use in combination and alone. This study evaluates renal function in children and adolescents (median age 16 years) at least 3 months following completion of a chemotherapy regimen which included 54 g/m2 ifosfamide, 360 mg/m2 cisplatin, doxorubicin, and high-dose methotrexate. PROCEDURE: Mean glomerular filtration rate (GFR) was determined by inulin or iothalamate clearance; proximal tubular function was evaluated by measuring fractional excretion of glucose (FEglu), tubular maximum phosphate reabsorption per GFR (TMP/GFR), FE of urate, and 24-hour amino acid excretion. Distal tubular function was evaluated by 24-hour urinary calcium, FE of magnesium, and urinary osmolality after water deprivation. Twenty-four-hour urinary protein excretion was measured. RESULTS: The mean GFR was 97 ml/min/1.73 m2. Although 10 of 24 patients had GFRs lower than normal, the lowest value was only 22% below the lower limit of normal and would not account for any clinical compromise. Proximal tubular function evaluation revealed normal FEglu, normal mean TMP/GFR values, and high FE of urate (1 5.7%). Two of twenty-four patients were shown to have mild generalized aminoaciduria. Distal tubular function evaluation showed normal 24-hour urinary calcium levels (mean 3.4 mg/kg) and FE of magnesium as well as normal urinary osmolality. Twenty-four-hour urinary protein excretion was normal in all patients. CONCLUSIONS: The lack of clinically significant renal abnormalities observed in patients who received combination chemotherapy with ifosfamide and cisplatin for osteosarcoma is encouraging for future osteosarcoma protocol development.

GFR determined by nonradiolabeled iothalamate using capillary electrophoresis.

Traditional measurements of glomerular filtration rate (GFR) in clinical practice include the measurement of serum creatinine or creatinine clearance. Increasing evidence concerning the limitation of these measurements in clinical practice and clinical trials has resulted in efforts to develop technologies that improve measurement of GFR. Recent efforts in that regard have used radioisotopic labeling of markers of GFR, such as 125I-iothalamate, and 51Cr-ethylenediaminetetraacetic acid. Limitations of these technologies include radiation exposure as well as cost considerations for the management of radioisotopes, including safety, disposal, mailing, and deteriorating activity that results in short shelf life. We report a test that used 0.5 mL Conray dye injected subcutaneously and subsequent measurement of the nonisotopic (cold) iothalamate by capillary electrophoresis in blood and urine. GFR using cold iothalamate compared with standard clearance using 125I-iothalamate was 0.99. The method is cost-effective and allows for avoiding exposure to isotopes, as well as problems such as the disposal and short shelf life of isotopes. This technology could allow for replacement of 125I-iothalamate as a marker for GFR.

Variation of free and total prostate-specific antigen levels: the effect on the percent free/total prostate-specific antigen.

OBJECTIVE: Recent studies have shown that calculations of the percent free/total prostate-specific antigen (PSA) improves the specificity of PSA testing. Characterizing the variability of free PSA and total PSA is necessary to evaluate the utility of an isolated free/total PSA measurement. We investigated the total variation of free and total PSA levels to determine how the percent free/total PSA was affected. DESIGN: Serum was obtained from nine urological patients on 5 different days over a 2-week period. Free and total PSA levels were measured on the day of collection. The total variation expressed in terms of percent coefficient of variation (%CV) was calculated, and the biological variation was derived taking analytical variation into consideration. SETTING: Patients were from Seattle (Wash) Urological Associates, and samples were processed at the Dynacare Laboratory of Pathology, Seattle, Wash. PATIENTS: Nine men (aged 48 to 69 years) were evaluated; three had been diagnosed with prostate cancer, three with benign prostatic hyperplasia, one with chronic prostatitis, one with high-grade prostatic intraepithelial neoplasia, and one was clinically normal. MAIN OUTCOME MEASURES: Total variation for free, total, and percent free/total PSA. RESULTS: The average total variation was 13.9% CV, 7.5% CV, and 10.6% CV for free, total, and percent free/ total PSA, respectively. Biological variation was derived to be 13.0% CV, 5.6% CV, and 8.0% CV for free, total, and percent free/total PSA, respectively. CONCLUSIONS: When applied, these results suggest that there are significant random changes in the numerator and denominator of the free PSA-total PSA ratio that could result in clinical misinterpretation. Clinicians must be aware that free PSA and total PSA levels will fluctuate owing to nonpathologic variation.

Development of a nonisotopic capillary electrophoresis-based method for measuring glomerular filtration rate.

The conditions for quantitative measurement of nonisotopic iothalamate meglumine (Conray) in urine and plasma by capillary zone electrophoresis (CE) have been developed. The impetus for developing this methodology was to replace the traditional [125I]iothalamate glomerular filtration rate (GFR) marker assay, a routine tool in the measurement of kidney function. This new approach for measuring kidney function is attractive since it avoids the cost of administration of radioisotopic compounds to patients, as well as the cost associated with purchase and disposal of isotopic compounds and contaminated samples. The concentration of iothalamate in urine and plasma determined by CE can be used directly to calculate GFR. The GFR in patients injected with [125I]iothalamate and nonisotopic iothalamate simultaneously showed an excellent correlation (0.998) with between-day coefficient of variation of 2.30% and a recovery of 102% and 98%, respectively, when added to urine and plasma. Interference from drugs and other urinary compounds is eliminated with this method. Collectively, this study has shown that CE is a cost-effective alternative to the current methodology for measuring GFR.

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.