[Effectiveness of in-patient internal-psychosomatic hospital treatment: Evaluation of a treatment-concept in Lower Austria]. / Effektivität stationärer internistisch-psychosomatischer Behandlung im Krankenhaus: Evaluation eines Behandlungskonzepts in Niederösterreich.

Effectiveness of in-patient internal-psychosomatic hospital treatment: Evaluation of a treatment-concept in Lower Austria Background: Medical care for psychosomatic patients in Austria differs from Germany. Besides treatment in psychiatric wards, there are also inpatient programs for psychosomatic patients integrated in internal medical departments. Such an integrated ward in Lower Austria operates for more than 35 years and treats internal-psychosomatic and gastroenterological patients. However, its effectiveness was not yet evaluated. Objective: The aim of the current study was to evaluate the effectiveness of an inpatient program for psychosomatic patients. Method: In total, 184 patients participated in the naturalistic study and filled in questionnaires at admission and discharge from inpatient treatment. Primary endpoint was the difference in global symptom burden, as well as symptom burden in the areas of somatization, anxiety, and depression as measured with the Brief Symptom Inventory (BSI) between admission and discharge. Secondary endpoints were body image (FKB-20) and subjective therapeutic success (BVB-2000). The predictive power of the Structure of Personality (OPD-SF) and adverse childhood experiences (ACE-D) was also investigated. A smaller sample of 59 patients also participated in a four-month follow up assessment. Results: The inpatient treatment was associated with improvement in the primary endpoints that can be interpreted as large effects. The effects were also small to large for the secondary endpoints, however, the improvement was smaller at the follow up time point. Patients with deficits in the dimensions regulation of relationships and internal emotional communication showed less improvement. Discussion: Symptoms improve over the course of the evaluated inpatient treatment program. Specific dimension of the structure of personality predict treatment response and should be considered in treatment planning. Conclusion: This study provides initial evidence for the presented internal-psychosomatic inpatient program. The program might act as model for psychosomatic medical care in Austrian hospitals.

Effect of tamsulosin on systemic blood pressure and nonneurogenic dysfunctional voiding in children.

PURPOSE: A number of therapies for dysfunctional voiding in children have been proposed after conservative measures have failed. Prior studies have shown significant improvement in lower urinary tract symptoms with alpha1-adrenergic antagonists. Nonselective alpha1-adrenergic antagonists can result in systemic vasodilatation and hypotension. We examined the effects of tamsulosin, a uroselective alpha1A-adrenergic antagonist, on blood pressure, as well as its safety and efficacy in the treatment of dysfunctional voiding in a pediatric population. MATERIALS AND METHODS: A total of 23 children without anatomical or neurogenic abnormalities presented with lower urinary tract symptoms refractory to conservative measures. All children had increased post-void residual urine or abnormal uroflowmetry in the absence of pelvic floor activity suggestive of bladder neck dysfunction. All patients were administered tamsulosin daily. Voiding diaries, blood pressure, uroflowmetry studies and patterns along with assessment of post-void residual urine were obtained before and after beginning tamsulosin in all children. RESULTS: Median duration of tamsulosin therapy was 7 months, and patient followup was 20 months. The number of voiding and incontinent episodes significantly decreased during treatment compared to baseline (p <0.05). Mean blood pressures before and during tamsulosin treatment were 98/55 mm Hg and 110/61 mm Hg, respectively. Significant increases in average and maximum urinary flow rates along with reduction in post-void residual urine were observed during tamsulosin therapy compared to baseline values (p <0.01). A 50% reduction in the number of abnormal uroflow patterns was observed with tamsulosin therapy. CONCLUSIONS: Tamsulosin demonstrated no clinically significant effect on blood pressure, while proving to be a safe and effective treatment option for lower urinary tract symptoms in a select pediatric population.