[Correlation in Crohn disease between psychiatric findings and site and kind of inflammatory extension]. / Zusammenhänge bei Morbus Crohn zwischen psychischem Befund und Ort und Art der Entzündungsausbreitung.

Research literature reveals a considerable heterogeneity in personality attributes of patients with Crohn's disease. The present study shows that these attributes correlate with the heterogeneous symptoms of the disease: By dividing the patients according to somatic aspects into two groups "typical for Crohn's disease" and "similar to ulcerative colitis" we found highly significant differences regarding psychological dimensions specially in the SCL-90-R-scales. The results concerning the "typical for Crohn's disease" subgroups are consistent with the patients' so-called "pseudo-independence" described in literature. By contrast, patients with a disease process "similar to ulcerative colitis", seemed to have a personality structure like patients with ulcerative colitis. Thus, psychological attributes may be differentiated according to location and kind of symptoms rather than to the entity of the two bowels diseases. The positive correlation between disease activity and self-rating psychological scales in the "typical for Crohn's disease" subgroups is interpreted as a break-down of defense mechanisms within an acute state of disease.

[Psychological effect of corrective surgery in female patients with structural and functional abnormalities of the jaws]. / Die psychologische Bedeutung korrektiver chirurgischer Eingriffe bei Patientinnen mit Form- und Funktionsanomalien des Kiefers.

20 young women (16 to 31 years of age) who underwent orthognatic surgery between 1979 and 1984 were subjected to an evaluation of their dental, orthognatic and psychological catamneses. The psychological results concerning operation motivation, preoperative stress and information, early postoperative condition and subjective assessment of the operative result are reported and discussed. Proposals are made to improve pre- and postoperative treatment of these patients.

Open-heart surgery: somatic predictors of postoperative psychopathology.

This study reports on some relationships between somatic conditions and postoperative psychopathological disturbances in 102 subjects from 20 to 65 years of age, undergoing open heart surgery. The overall incidence of postoperative psychiatric complications was 40%. Only two variables showed a significant correlation with the psychiatric criteria we used, independent of the different diagnoses: body weight and preoperative urea-N levels in serum. Some of the somatic predictors reported in the literature could be found to be specific for mitral or aortic valve disease. Predictors for psychiatric complications in patients with aortic valve replacement were: age, preoperative protein and urea-N levels in serum, and daytime sedation. The predictor in mitral valve replacement was the decrease in venous oxygenation (pulmonary artery) under physical strain.

[The relative ejection time under different conditions of cardiac stress and in aortic valve disease (author's transl)]. / Untersuchungen der relativen Austreibungszeit unter verschiedenen Belastungen und bei Aortenvitien.

In 51 healthy young people the carotid arterial pulse wave was registered externally during bicycle-exercise in a lying position. The ejection time in relation to the duration of diastole (not pulse period or heart rate!) increased significantly. These results are compared with measurements made by Schulz (15) who found normal ejection times in tachycardia provoked by pacer-stimulation and shortened values during isoproterenol-induced tachycardia. Women have longer ejection times than men especially under physical stress. In 18 patients suffering from aortic insufficiency, ejection times were slightly prolonged and in 28 patients who had a systolic pressure gradient of more than 20 mm Hg between the left ventricle and the aorta ejection times were markedly prolonged. There is also a significant positive correlation between ejection time and pressure gradient. The authors consider that the autonomic innervation plays an important role in the duration of ejection time in normal subjects while in patients with aortic heart disease the ejection time is predominantly influenced by mechanical factors. For the diagnosis of the severity of aortic stenosis measurements of ejection time are only useful in connection with other clinical parameters (pulse pressure, creast time of the arterial pulse wave).

Open-heart surgery from the psychological point of view and resulting therapeutic considerations.

A total of 168 patients underwent thorough psychological investigation before and after open-heart surgery. The pre-operative psychological status and the psychosocial situation of the patients were studied by means of questionnaires and semi-standardized interviews. The post-operative psychic status was documented daily on the first four post-operative days and once after discharge from the intensive care unit, by means of a slightly modified version of the AMP rating scale. We found significant correlations between psychosocial problems, the patients' ability to cope with their illness, the surgical stress and the environmental stress of the intense care unit, and post-operative psychic disturbances. The results lead to deliberations on therapeutic consequences.

[Problems in the classification of psychopathological disorders following cardiac surgery with extracorporeal circulation]. / Probleme der Klassifizierung psychopathologischer Auffälligkeiten nach Herzoperationen mit extrakorporaler Zirkulation.

Classifications of postoperative psychopathological disorders after heart surgery according to the literature are very different as the results are dependent upon the accuracy of the observation. The accuracy and choice of classification are important as the base for identifying causal factors. We studied 214 patients using three alternative methods of classification and discuss problems of classification of the postoperative psychopathological dysfunctions.

[Some psychological predictors for psychosis after open heart surgery (author's transl)]. / Einige psychologische Prädiktoren für psychische Auffälligkeiten nach Herzoperationen.

In a study of postoperative psychosis after open heart surgery three psychopathological syndromes were identified which had different psychological predictors. Predictors of postoperative emotional disturbances are family problems and the lack of plans for the future, whereas patients with postoperative disorientations seem to have difficulties in their jobs and therefore feel distressed preoperatively. Predictors of the paranoid syndrome after the operation are: a high degree of fear in awaiting the operation and little confidence in the doctors. The social surroundings of these patients are often unstable and although they have no precise plans for the future they object to start working again after operation.

[Some somatic and psychological predictors of psychopathological disorders after cardiac surgery (author's transl)]. / Einige somatische und psychologische Prädiktoren für psychopathologische Auffälligkeiten nach Herzoperationen

Some new predictors of postoperative psychosis in open-heart surgery have been identified in a multifactorial study of somatic and psychological factors: Somatic predictors are lower body weight, higher blood levels of urea nitrogen and creatinine, preoperative use of tranquilizers, especially in patients with double valve replacement or congenital heart disease and preoperative cerebral embolism in mitral valve disease. Bypass-time has not proved to be a valid predictor. Psychological predictors are distress provoked by severity and duration of illness, repeated delay of surgery as well as the manner of psychological coping with the illness.