Neuropsychological dysfunction, depression, physical disability, and coping processes in families with a parent affected by multiple sclerosis.

BACKGROUND: Families with a parent suffering from multiple sclerosis (MS) must cope with the unpredictable course of the disease. Most studies analyzing factors that influence coping abilities in families with a member affected with MS used questionnaires to assess this ability. METHODS: On the contrary, the present study used a semi-structured psychiatric interview and used the resulting information to calculate a general measure of coping ability (coping index [CI]). We administered this interview to 44 MS patients, their partners and offspring and conducted a neuropsychological and physical evaluation of the patients to determine the impact of physical disability, cognitive dysfunction, and depression on the process of coping by the patient, the healthy partner, and children. RESULTS: The CI of patients was best predicted by measures of their depressive symptoms, divided attention, and estimated verbal intelligence. None of the patient variables predicted the CI of healthy partners or their offspring. We found an association between the CI of the healthy partner and the children. CONCLUSIONS: These findings suggest that MS patients' emotional and neuropsychological functions are associated with their ability to cope with the disease. These should be carefully assessed at the beginning of treatment so that those factors known to negatively influence patient coping are targeted in the treatment plan if necessary. Comprehensive care of a patient with MS should include support of coping abilities of the family members.

Disease variables and depression affecting the process of coping in families with a somatically ill parent.

AIM AND METHODS: Based on the investigation of 134 families with a seriously ill parent and 214 offspring, we compared--by means of semistructured psychiatric interviews--the capacity of the ill and the healthy parent and their children to cope with various diseases. We evaluated how disease characteristics such as duration and severity of the disease (assessed by the Karnofsky Index) and associated depression [measured by the Beck Depression Inventory for parents and the Depression Inventory for Children and Adolescents (Depressions-Inventar für Kinder und Jugendliche) for children] influence the coping capacity of all family members. RESULTS: The coping capacity of patients with organic disease (cancer, multiple sclerosis, other somatic diseases) is significantly higher than that of patients with somatization disorder, whereas the depression score of patients with organic disease is significantly lower than that of patients with somatization disorders. The depression of the patient negatively influences his/her coping capacity. Children's coping capacity does not differ with respect to the parental illness and is not influenced by their own depression. There are significant correlations between the coping capacity of children and their healthy and ill parents affected by organic disease (multiple sclerosis, other somatic diseases, cancer), but not between children and healthy and ill parents with somatization disorders. Multivariate regression analysis shows the mutual influence of coping capacities between the parental couple as well as between the parents and their children. The better the patient (partner) is able to cope with a severe disease, the higher are the values of the coping capacity of the partner (patient). Children older than 6 years with a severely ill, nondepressed and well-coping parent cope well. These results do not apply to parents with somatization disorders. CONCLUSIONS: Patients with organic disease cope better and are less depressed, whereas patients with somatization disorders have a lower coping capacity and a higher depression score. Children older than six years cope better. Comprehensive care of a patient with a severe illness has to include his/her family in order to evaluate coping capacities of all family members, particularly of small children, and to assess and treat associated parental depression.

Indication for psychotherapy in offspring of a parent affected by a chronic somatic disease (e.g. multiple sclerosis).

Based on the transcripts of video-recorded, semi-structured interviews with 41 offspring (aged 6-18 years) of parents with multiple sclerosis, we evaluated the indication for psychotherapy. These results were then compared with the previously determined coping ability of each child/adolescent. Psychotherapy was indicated for 22 out of the 41 children/adolescents. There was a significant relation between the indication for psychotherapy and the children's inability to cope with the parental disease. The present findings confirm the risk of mental health problems in children of somatically ill parents. In our sample, half of the children and adolescents were estimated to benefit from individual psychotherapy, which might enhance their ability to cope with the parental illness.

Gender-specific differences in the process of coping in families with a parent affected by a chronic somatic disease (e.g. multiple sclerosis).

Based on the investigation of 52 families and their 87 offspring by means of semistructured interviews, we evaluated the coping abilities of the parent affected by multiple sclerosis (MS), the healthy parent and their children. The results show that the gender of the child significantly influences his or her coping behaviour. Daughters cope better than sons, independently of the gender of the MS-affected parent. Only the daughter's coping is positively affected by age and disease variables. The correlation between the coping behaviour of parents and children is significant between children and their healthy parents and even stronger between children and healthy parents of the same gender. Healthy mothers and daughters cope better with the increasing disability of the father. This is not the case for healthy fathers and sons. Gender seems to be an important moderating factor in chronic parental disease and it has complex effects on the coping capacity of children.

[Adoption and/or reproductive medicine]. / Adoption und/oder Reproduktionsmedizin.

Adoption and medically assisted reproduction are alternative options for childless parents to fulfill their wish for having a child. In both situations, there is a necessity for the future parents to mourn the loss of their imagined child, which could have been conceived without a third party (adoption agency or medically assisted reproduction). Adoption always represents for the child a loss of emotional ties with birthparents and the development of new attachments with adoptive parents. Adoption can be considered as a lifetime process of the members involved in the adoption triangle, that is birth parents, adoptive parents and the child. The article discusses the loss of emotional bonds from primary caretakers as a psychological trauma and addresses mourning difficulties in adoptees. Problems with the development of new attachments with adoptive parents such as loyalty conflicts and the revelation of the adoption are described. Family romance fantasy in adoption and aspects of family dynamics as well as the specific difficulties adoptive parents encounter are explored.

[Parent child relations problems in adoption]. / Eltern-Kind-Beziehungsproblematik bei der Adoption.

Adoption always represents for the child a loss of emotional ties with birthparents and a development of new attachments with adoptive parents. Adoption can be considered as a life-time process of the members involved in the adoption triangle, that is birth parents, adoptive parents and the child. The article discusses the loss of emotional bonds from primary caretakers as a psychological trauma and addresses mournings difficulties in adoptees. Problems with the development of new attachments with adoptive parents such as loyalty conflicts and the revelation of the adoption are described. Family romance phantasy in adoption and the search for their origin by young adoptees are also explored. Aspects of family dynamics in the adoptive process and the specific difficulties adoptive parents encounter are reviewed. Preventive and therapeutic measures are presented.

[Comprehensive medicine from the child and adolescent psychiatry viewpoint]. / Ganzheitsmedizin aus kinder- und jugendpsychiatrischer Sicht.

The development of a child or a adolescent and it's (psycho-)pathological manifestations call often for a multidisciplinary approach. The specialist for child and adolescent psychiatry has in such situations a coordinating and integrating function with direct involvement. His goal is therefore--be it during diagnostic or therapeutic procedures--to guarantee an attunement of biological, medical, psychological, psychiatric, pedagogical and social perspectives, to favor reflective conceptualisation and the cooperation of all the involved persons and institutions.

[The use of radiation sources in solariums]. / Anwendung von Strahlungsquellen in Solarien

Solaria are increasingly in favour. As radiation sources, the following ones have proved useful: high-pressure mercury-vapour lamps, compound radiation systems consisting of high-pressure mercury-vapour burner, series coiled filament and reflector bulbs made of special glass as well as halogen metal-vapour lamps. The spectral distributions of irradiances of these emitters, the spatial and local distribution of their radiant intensity or irradiance respectively are reported as well as the balance of emitted energy, i.e. the distribution of radiant power over the different wave ranges. Demands of radiation technics are pointed out, which ought to be considered for the construction of solaria.