Alexithymia is no risk factor for exacerbation in spasmodic torticollis patients.

OBJECTIVE: To assess whether alexithymia is a risk factor for exacerbation in spasmodic torticollis (ST). METHODS: ST patients (2 x 10) with high vs. low alexithymia scores (mean score on the 20-item Toronto Alexithymia Scale [TAS-20]=69.2 vs. 28.7) were compared on physiological, motor and subjective responses to a cognitive and an emotional laboratory stressor. Changes in sustained abnormal head/shoulder positions and maximum range of motion (ROM) of the cervical spine were kinematically quantified. Skin conductance level (SCL), nonspecific skin conductance fluctuations (NS.SCF), heart rate (HR) and skin temperature (T) were measured. RESULTS: High alexithymia had no effect on the abnormal head posture or movements, but high-alexithymic ST patients showed generally increased levels of autonomic arousal (more NS.SCF, higher SCL; analysis of variance [ANOVA]: P=.016 and P=.051, respectively) under all experimental conditions. When ST symptom severity (TSUI-score) was partialled out, these group differences were somewhat reduced (analysis of covariance [ANCOVA]: P=.052 and P=.143). CONCLUSIONS: High alexithymia did not lead to increased abnormal head movements to stressors, but may result in a subtle increase in tonic level of sympathetic activity.

[The effectiveness of the initial interview at a psychosomatic- psychotherapeutic outpatient unit]. / Uber den Nutzen von Beratungsgesprächen einer psychosomatisch-psychotherapeutischen Ambulanz.

In a cross sectional study of 1945 consecutive patients seen at a psychosomatic-psychotherapeutic outpatient unit between 1993 and 1995, we investigated how the therapists assessed the effectiveness of their work and what correlations there were with patient characteristics and with the way the therapists conducted the initial session. The therapists' ratings indicated that about two thirds of the patients benefited from the consultation. In the multivariate analysis of the data the most important determinants of effectiveness were found to be the patient's motivation, the ICD diagnosis, the patient's level of personality organisation and the reason for the consultation. In addition, we did a one-year follow-up of 260 patients to analyse the determinants that help patients to agree to the proposed treatment plan. Of the 235 patients for whom treatment was recommended, 174 (74%) actually began a treatment program. Our results show that a patient is more likely to accept the treatment recommendation if the therapist conducts the session in a certain way (e.g. provides detailed information) and helps the patient to find an appropriate therapist.

[Current perspectives of alexithymia]. / Aktuelle Perspektiven der Alexithymie.

Although alexithymia is found in patients with various somatic disorders, it remains unclear whether it is really related to organic disease--as proposed by the founders of the concept.[125]. As the interplay between the experience of emotion and possible adverse effects on health is a fundamental tenet of psychosomatic medicine, alexithymia remains an interesting concept to be further explored, especially concerning (1) possible pathways linking emotion to physical illness and (2) the neurobiologic basis of emotional information processing. Compared to the intense international discussion on the subject, in Germany there are still many doubts concerning alexithymia: while some clinicians question the validity of the whole concept, psychiatric and psychosomatic researchers seem unsure about alexithymia's role in their search for a physiological basis to the link between emotion and physical disease. Our review deals with the empirical literature concerning that possible association and tries to tie in their data with modern, neuro-biologically founded insights into emotional information processing within the brain.

Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior?

OBJECTIVE: This study examines factors affecting the frequency of physician consultations by individuals with functional gastrointestinal disorders (FGD) in a group of subjects with functional dyspepsia or irritable bowel syndrome. Systematic selection of persons who were already seeing a physician for one of these problems was avoided by conducting an epidemiological field study rather than a clinical study. METHODS: A representative sample of the German population (N=2201) completed a questionnaire that included, in addition to the criterion (number of physician visits in the past 12 months), items aimed at identifying the target group and questions about physical symptoms, illness behavior, living situation, personality features, and sociodemographic status (a total of 31 predictors). RESULTS: Individuals with functional gastrointestinal disorders who consulted a physician for their gastrointestinal disorders and those who did not differed significantly, especially on psychological measures. The differences between these individuals and the general population were greater for the consulters than for the nonconsulters. Multiple regression analyses yielded nine predictors that explained 40.2% of the variance of the criterion. The best predictors of frequency of physician consultations were the duration of periods with symptoms and psychological factors, such as the severity of depression and the patients' views on the cause of their illness. CONCLUSIONS: The psychopathology seen in people with functional gastrointestinal disorders is of two types: one is a characteristic of the illness itself and the other leads the individual to consult a physician. When gastroenterologists see patients with such disorders, they can assume that they may be dealing with a self-selected group of individuals with psychological stress. Psychological assessment would, therefore, be useful to determine whether a given individual with FGD might benefit from psychotherapy.

[Psychotherapy and psychoanalysis in patient management: results of the Heidelberg Catamnesis Project]. / Psychotherapie und Psychoanalyse in der Krankenversorgung: Ergebnisse des Heidelberger Katamnese-Projektes.

In the "Heidelberg Long Term Psychotherapy Follow-up Project", a naturalistic study design, all types of treatment were included that had been performed at the Psychosomatic Clinic of the University of Heidelberg for a certain period (combined inpatient and outpatient individual and group therapy, as well as outpatient dynamic psychotherapies and psychoanalyses). The specific value of this project is due to the fact that--apart from many other, for instance psychological, assessment evaluations--three to five individual therapy goals had been predetermined for each patient before starting the treatment (goal attainment scaling). After the end of therapy and at the time of follow-up (3.5 years later on the average), attainment of these goals was assessed by an independent rater. A total of 208 patients were examined who were evaluated according to their diagnosis (neurotic, functional or psychosomatic disorders) and the kind of treatment. With regard to symptomatology, individual therapy goals, psychological assessment and patient satisfaction, the overall results were good, partly very good, and were almost invariably stable during the long follow-up period. Two particular results are discussed separately: 1. As far as symptomatology was concerned, the group of psychoanalysis patients could not maintain the good outcome at the end of therapy during the long follow-up period. 2. Patients with "psychosomatic disorders" attained remarkably good results, particularly if the treatment had initially been an inpatient setting.

Similarities and differences in couples' grief reactions following a miscarriage: results from a longitudinal study.

Recent studies have documented grief and depressive reactions in women after a miscarriage. However, the men's reactions to their partner's experience have been neglected. In a controlled follow-up study, 56 couples were studied shortly after the miscarriage, and 6 (N = 47) and 12 months later (N = 45). The participants completed standardized questionnaires for depression, physical complaints, anxiety, and grief. Contrary to commonly held beliefs, men do grieve, but less intensely and enduringly than their partners. The manner in which they experience their grief is similar to that of the women, except that the men cry less and feel less need to talk about it. Unlike the women they do not react with an increased depressive reaction (compared to age- and sex-matched community control groups). Giving up their personal expectations, hopes for, and fantasies about the unborn child is a major source of grieving for both. Some men feel burdened by their wives' grief or depressive reactions. Conflicting reactions may affect the couples' interactions and promote depressive reactions in the women.

[Psychotherapy as a career]. / Psychotherapie als Beruf.

The author discusses the professional world and setting of a psychotherapist against the background of his subjective and personal experience manifested by typical polarities and fields of tension that exemplify in equal measure both the special features and the risks inherent in this "impossible vocation". The following problems and polarities are dealt with in detail: 1. Who chooses or is apt to become a psychotherapist? 2. Vocational training somewhere between method-oriented meticulousness and innovative keenness to experiment. 3. Self-image--projected (foreign) image. 4. Own life--foreign life. 5. Innermost reality and individual difficulty in respect of external reality and social integration.

Grief and depression after miscarriage: their separation, antecedents, and course.

Bereavement is a major risk factor for physical illness, grief, depression, and anxiety. In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeutic, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnancy, to make this point. Clinical criteria for differentiating grief and depressive reactions were developed based on phenomenological criteria and theoretical considerations. We hypothesized that the detrimental psychological and physical consequences occur only when the miscarriage was not mourned and resulted in a depressive reaction, but not in a grief reaction. In a controlled, representative study, 125 consecutive women were assessed shortly after their miscarriage (before the 20th week of gestation) and 6 months (N = 94) and 12 months (N = 90) later. Assessments included standardized questionnaires for life events, depression, physical complaints, anxiety, and a specific, multidimensional grief scale (Munich Grief Scale) that we had developed previously. Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-matched community controls. Twenty percent of the patients who had miscarried showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As predicted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depressive reactions were predicted by a history of previous depression, a lack of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.

[Assessment of grief exemplified pregnancy loss: development and initial results on the validity of the Munich Grief Scale]. / Erfassung von Trauer am Beispiel des Verlustes einer Schwangerschaft: Entwicklung und erste Ergebnisse zur Validität der Münchner Trauerskala.

Bereavement research is hampered conceptually by confounding of grief and depression, methodologically by a lack of generally agreed-upon measures. Therefore we developed the Munich Grief Scale (MGS) based on the Perinatal Grief Scale (PGS, Potvin et al. 1989) and results from a previous study. Validation included comparisons with standardized self-report scales of depression, anxiety and physical symptoms. It was based on a follow-up study of 125 patients who had miscarried and 3 comparison groups who either suffered from a miscarriage or a stillbirth. Self-reports were compared to expert ratings of grief and depression. The MGS is a economical, reliable self- and expert rating scale after pregnancy loss. The applicability of the grief measures to other kinds of bereavements remains to be determined.

[DKPM basic documentation. A uniform basic documentation for inpatient psychosomatic treatment and psychotherapy]. / DKPM-Basisdokumentation. Eine einheitliche Basisdokumentation für die stationäre Psychosomatik und Psychotherapie.

The Arbeitsgemeinschaft Basisdokumentation presents the DKPM-Basisdokumentation, which is conceptualized as a uniform modul of a documentation system for the routine-like use in the in-patient psychosomatic and psychotherapy. We outline possibilities of use, aspects of the data security and the data access as well as some practical presuppositions.

[Psychological factors of non-ulcer dyspepsia]. / Psychologische Faktoren der Non-Ulcer Dyspepsia (NUD).

Given the absence of any demonstrable organic reason for non-ulcer dyspepsia, and the well known fact, that the psyche influences stomach function, it is widely held, that psychological factors cause NUD. To now, studies are concerned with the psychopathology and personality of NUD-patients, their illness behaviour, and with the relation between stress and abdominal pain. A critical review of these studies revealed, that among the psychological variables mainly anxiety and illness behaviour seems to play a central role in NUD. However, future studies should focus more on the distinction towards other functional disorders and on the differentiation within the heterogeneous group of NUD-patients (especially with regard to physiological variables). Besides this, it seems rewarding to examine the so far scientifically neglected group of subjects with abdominal pain, who do not contact a physician.

[Therapeutic factors of inpatient psychotherapy--the patients' view]. / Therapeutische Faktoren bei stationärer Psychotherapie--Die Sicht der Patienten.

Inpatient psychotherapy as a complex treatment program coordinates a multitude of specific, possibly therapeutic helpful components. At least in departments of about 20 or more beds the available therapeutic components are composed or dosed in a different kind for certain groups of patients (indication). In the Psychosomatic Clinic with a ward of 22 beds patients with certain psychoneurotic symptoms, bodily dysfunction or psychosomatic illnesses take part in different inpatient psychotherapy programs for 3 months. This very intensive treatment phase is regularly followed by an outpatient psychoanalytic oriented individual or group-psychotherapy for 1 or more years. For the inpatient treatment phase we differentiate 18 possibly therapeutic helpful factors. Preparing systematic studies we asked the patients at the end of their inpatient treatment phase to judge: to what extent the 18 single factors were helpful. Furthermore a personality questionnaire (Giessen-Test) and a checklist of complaints (Giessen Checklist of Complaints) were routinely filled out by the patients pre and post their inpatient time. From this data we derive independent success-scores which enables us to investigate the association between the subjective assessment of the helpfulness of certain therapeutic factors and somewhat independent criterions. The given data of n = 291 patients allow a empirically based discussion of the question: "What relevance do certain components of inpatient psychotherapy alone or together with other components have for certain groups of patients or specific settings?