Kidney donors' quality of life and subjective evaluation at 2 years after donation.

OBJECTIVE: The aim of this study was to investigate the quality of life of renal donors and their subjective evaluation of the donation during long-term follow-up. PATIENTS AND METHODS: We interviewed 11 donors 2 to 3 years after kidney donation. The interviews were audiotaped, transcribed, and analyzed by qualitative content analysis based on grounded theory. We grouped the resulting categories to form ideal types of subjective outcome after kidney donation. RESULTS: Of the donors, 64% were female. Mean age was 40.4 years. All donors reported that they had had no medical problems after donation. Most donors experienced some form of psychological problem, such as difficulties adjusting to the new situation at home, hypochondriacal complaints and heightened awareness of bodily sensations, and fear of rejection of the recipient's kidney. Most of the donors felt their relationship to the recipient was good; some had ambivalent feelings toward the kidney recipient. Three main ideal types of donors can be differentiated: the "happy helper," the "ambivalent partner," and the "hypochondriacal complainer." CONCLUSIONS: Although donors' subjective outcome after living kidney donation seems to be generally positive, it is worthwhile for the clinician to look for possible psychological problems after donation. Relating a donor to one of the described ideal types may help identify specific difficulties and guide the tailoring of individual psychological interventions. All interviewed donors wished for extended counseling after kidney donation.

SPECT patterns in probable Alzheimer's disease.

The primary objective of this study was to test hypotheses about the relationship between HMPAO-SPECT findings and probable Alzheimer's disease (DAT) in a relatively large sample of patients diagnosed according to DSM-III-R. SPECT patterns of 20 controls and 116 DAT patients were investigated. Left and right frontal, temporal, parietal and occipital regions of the brain were rated as showing a hypoperfusion or not. A wide variety of patterns were found and these are described in detail below. In DAT patients, temporal and/or parietal regions were affected significantly more often (88%, p > 0.001) than frontal and/or occipital regions (70%). A bilateral temporoparietal pattern, which has been repeatedly reported as typical for DAT, was observed in 48% of DAT patients, but also in 25% of controls, and did not differentiate significantly between these two groups (p > 0.05). Conversely, more than three regions with hypoperfusion were observed significantly more often in DAT patients (48%, p < 0.01) than in controls (10%). In DAT patients, the number of regions with hypoperfusion correlated significantly with the score of the Mini Mental State Examination (MMSE, r = 0.33, p < 0.001). The frequency of at least one hypoperfusion was approximately equal in left and right hemispheres (77% vs. 73%, p = 0.2). The hypothesis that cognitive decline in DAT starts in the temporal regions was tested in 14 SPECT patterns showing only one region with hypoperfusion. In 12 of these patterns, a temporal region was in fact affected (p < 0.001). Whereas hypoperfusion in frontal areas was not accompanied by a significantly lower MMSE than when only temporoparietal regions were affected, MMSE scores were significantly lower when occipital regions were affected in addition to temporoparietal regions (p < 0.05). The clinical use of SPECT findings was tested in discriminating analyses with the MMSE and a delayed recall test as additional predictors of DAT. Whereas the MMSE and the delayed recall test differentiated significantly between DAT patients and controls, SPECT findings yielded no further differentiation. In conclusion, the theoretical and clinical implications of SPECT findings and their relationships to other physiological and psychological variables deserve further investigation.

[Communicated insanity, folie a deux and shared psychotic disorder. Different concepts and a case from Mallorca]. / Induziertes Irresein, Folie à deux und gemeinsame psychotische Störung. Verschiedene Konzepte und ein Fallbeispiel auf Mallorca.

Following an earlier description of the psychopathological conceptions of "communicated insanity" we focus on a remarkable difference concerning the development of the historical terminology. The current operationalized definition is oriented at the originally French conception of the "folie à deux" which includes an adoption of certain delusional ideas by an intimate other. Compared with that, in the German psychopathological tradition those cases were also included in the conception of the "induziertes Irresein", in which the shocking experience of another's psychosis may cause a psychotic illness of somebody else. In modern psychiatric terminology this kind of "induction" is rather disregarded. We report a case of an induced psychosis in two women and give particular attention to the German psychopathological tradition because of still existing clinical relevance.