[Psychological stress and impaired quality of life in patients with tinnitus]. / Psychische Belastungen und Einschränkungen der Lebensqualität bei Patienten mit Tinnitus.

OBJECTIVES: The majority of patients with chronic decompensated forms of tinnitus have comorbid psychological disorders, possibly accompanied by restricted quality of life and participation in everyday activities. There is no standardized tool to measure these clinically relevant dimensions. SAMPLE AND METHOD: Both the Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 (SF-36) were administered to a consecutive sample of patients ( n=110) who were recruited from the tinnitus outpatient service in the department of psychiatry and psychotherapy. Using the Tinnitus Questionnaire (TF), associations of the HADS and SF-36 scales with tinnitus grading were determined and the classification of patients (mild-medium-severe-very severe) was evaluated. RESULTS: A severe tinnitus grading is correlated to a high extent of anxiety and depression and a low quality of life. With the exception of the SF-36 subscale on physical functioning, all scales discriminated between the extreme groups (mild vs severe/very severe), but less between the two medium groups. CONCLUSIONS: Patients with severe decompensated tinnitus (grades III and IV) should be seen for diagnosis of psychiatric comorbidity and supportive psychotherapy/psychopharmacotherapy used when necessary.

[Neurobiological findings in a patient with 48-hour rapid cycling bipolar affective disorder. A case report]. / Neurobiologische Befunde bei einem Patienten mit 48-h-Rapid-cycling bei bipolar affektiver Erkrankung. Eine Kasuistik.

Forty-eight-hour rapid cycling is a rare subclass of affective disorders and entails a regular periodic change of moods. The following case study describes the symptoms, therapy, and outcome of a patient suffering from daily switching between mania and depression along with neurobiological findings correlated to the affective cycles. We found alternating reduction and prolongation of sleep duration during manic and depressive days as well as differences in the amount of REM sleep. Cortisol secretion was regularly increased during depressive days. Regarding thyroid-stimulating hormone (TSH) secretion, the circadian rhythm was absent on depressive days. However, the glucose metabolic rate as measured by positron emission tomography (PET) did not differ on manic and depressive days. The patient reached almost complete remission under treatment with lithium.

[Sleep disorders. Differential diagnosis and therapy in general practice]. / Schlafstörungen. Differenzialdiagnose und Therapie in der hausärztlichen Praxis.

Sleep Disorders are one of the most common complaints of patients seen by general practitioners. Prevalences vary considerably--depending on the kind of research and the definition of sleep disorders--between 4 and 40%. In 2000 the first grand nationwide survey was carried out in primary care settings [1]. 12.3% of the 17,928 questioned stated sleep disorders as the main reason for their consultation, the prevalence of all kinds of sleep disorders being 29%. Like seen in other studies sleep complaints increased with age and predominated significantly in women. In one-third of the sample the differential diagnosis was primary or non-organic insomnia [1] while treatment was mainly conducted by the general practitioner. In two-thirds of the patients sleep disorders existed for more than 12 months while 41%--by their own account--took sleep agents at least once a week. This article gives an overview of the causes and treatment of sleep disorders, particularly therapy of non-organic insomnia.

Evaluation of a structured treatment and teaching programme on asthma.

The objective of this study was to evaluate a structured treatment and teaching programme for adult patients with moderate to severe asthma. The design consisted of a prospective, before-after trial: the same consecutive patients were studied before and after intervention with observation periods 1 year before and 1 year after intervention. The investigation took place within a tertiary care centre (university hospital). A total of 142 consecutive patients were referred for in-patient treatment of their asthma, of whom 132 (93%) patients participated in the follow-up examination. The intervention consisted of a structured 5-d in-patient treatment and teaching programme presented by a specialized nurse educator. The aim of the programme was for the patient to assume greater responsibility for disease management, including self-monitoring of peak expiratory flow and qualified self-adaptation of drug therapy. The main outcome measures were the frequency of severe asthma attacks, hospitalization, and absenteeism from work (data provided by health insurance companies), patients' compliance and management skills. During the year before and the year after the intervention 71% and 36%, respectively of patients had one or more severe asthma attacks (mean difference 35%, 95% CI: 25-45%, P less than 0.0001). The percentage of patients who were hospitalized because of asthma decreased from 39% to 22% (mean difference 17%, 95% CI: 7-27%, P less than 0.002). The percentage of employed patients (n = 67) who were absent from work because of asthma decreased from 60% to 43% (mean difference 17%, 95% CI: 4-30%, P less than 0.04). The patients' adherence to maintenance drug therapy and their management skills improved significantly. It was concluded that the participation of patients with moderate to severe asthma in a structured treatment and teaching programme resulted in a substantial reduction in asthma morbidity in the year following the intervention.

[Anxiety and illness behavior in bronchial asthma]. / Angst und Krankheitsverhalten bei Asthma bronchiale.

In 82 patients attending a one-week asthma self-management education program, asthma symptom anxiety, personality trait anxiety, and attack-related coping styles were correlated with attack frequency, medication regimen and pulmonary function parameters. In 21 patients, asthma symptoms anxiety was shown to influence illness behaviour at follow-up one year later: in patients with severe asthma, greater symptom anxiety was associated with more suitable illness behaviour. Moreover, suitable illness behaviour appears to be related to cognitive coping styles that take into account the asthmatic's feeling of dependency in attacks without denying them.