- [Show abstract] [Hide abstract] ABSTRACT: The primary aim of this study was to investigate facial emotion recognition in patients with somatoform disorders (SFD). Also of interest was the extent to which concurrent alexithymia contributed to any changes in emotion recognition accuracy. Twenty patients with SFD and twenty healthy, age, sex and education matched, controls were assessed with the Facially Expressed Emotion Labelling Test of facial emotion recognition and the 26-item Toronto Alexithymia Scale (TAS-26). Patients with SFD exhibited elevated alexithymia symptoms relative to healthy controls. Patients with SFD also recognized significantly fewer emotional expressions than did the healthy controls. However, the group difference in emotion recognition accuracy became nonsignificant once the influence of alexithymia was controlled for statistically. This suggests that the deficit in facial emotion recognition observed in the patients with SFD was most likely a consequence of concurrent alexithymia. Impaired facial emotion recognition observed in the patients with SFD could plausibly have a negative influence on these individuals' social functioning.
- [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to investigate cortisol levels as a function of the hypothalamic-pituitary-adrenal axis (HPA) in relation to alexithymia in patients with somatoform disorders (SFD). Diurnal salivary cortisol was sampled in 32 patients with SFD who also underwent a psychiatric examination and filled in questionnaires (Toronto Alexithymia Scale, TAS scale; Screening for Somatoform Symptoms, SOMS scale; Hamilton Depression Scale, HAMD). The mean TAS total score in the sample was 55.6+/-9.6, 32% of patients being classified as alexithymic on the basis of their TAS scores. Depression scores were moderate (HAMD=13.2, Beck Depression Inventory, BDI=16.5). The patients' alexithymia scores (TAS scale "Difficulty identifying feelings") correlated significantly positively with their somatization scale scores (Symptom Checklist-90 Revised, SCL-90-R); r=0.3438 (P<0.05) and their scores on the Global Severity Index (GSI) on the SCL-90-R; r=0.781 (P<0.01). Regression analysis was performed with cortisol variables as the dependent variables. Cortisol levels [measured by the area under the curve-ground (AUC-G), area under the curve-increase (AUC-I) and morning cortisol (MCS)] were best predicted in a multiple linear regression model by lower depressive scores (HAMD) and more psychopathological symptoms (SCL-90-R). No significant correlations were found between the patients' alexithymia scores (TAS) and cortisol levels. The healthy control group (n=25) demonstrated significantly higher cortisol levels than did the patients with SFD; in both tests P<0.001 for AUC-G and AUC-I. However, the two groups did not differ in terms of their mean morning cortisol levels (P>0.05). The results suggest that pre-existing hypocortisolism might possibly be associated with SFD.
- [Show abstract] [Hide abstract] ABSTRACT: In this multicentre study on multiple chemical sensitivity (MCS) 291 consecutive environmental medicine (EM) outpatients were examined in several environmental medicine outpatient centres/units throughout Germany in 2000/2003. Of the EM outpatients, 89 were male (30.6%) and 202 were female (69.4%), aged 22-80 (mean 48 years, S.D.=12 years). The sample was representative for university-based environmental outpatient departments and represented a cross-sectional study design with an integrated clinical-based case-control comparison (MCS vs. non-MCS). Three classifications of MCS were used: self-reported MCS (sMCS), clinically diagnosed MCS (cMCS), and formalised computer-assisted MCS with two variants (f1MCS, f2MCS). Data were collected by means of an environmental medicine questionnaire, psychosocial questionnaires, the German version of the Composite International Diagnostic Interview (CIDI), and a medical baseline documentation, as well as special examinations in partial projects on olfaction and genetic susceptibility markers. The hypothesis guided evaluation of the project showed that the patients' heterogenic health complaints did not indicate a characteristic set of symptoms for MCS. No systematic connection could be observed between complaints and the triggers implicated, nor was there any evidence for a genetic predisposition, or obvious disturbances of the olfactory system. The standardised psychiatric diagnostics applying CIDI demonstrated that the EM patients in general and the subgroup with MCS in particular suffered more often from mental disorders compared to an age and gender matched sample of the general population and that in most patients these disorders commenced many years before environment-related health complaints. Our results do not support the assumption of a toxicogenic-somatic basis of the MCS phenomenon. In contrast, numerous indicators for the relevance of behavioural accentuations, psychic alterations or psychosomatic impairments were found in the group of EM-outpatients with subjective "environmental illness".
- [Show abstract] [Hide abstract] ABSTRACT: Borderline patients often display pathological aggression. We previously tested lamotrigine, an anti-convulsant, in therapy for aggression in women with borderline personality disorder (BPD) (J Psychopharmacol 2005; 19: 287-291), and found significant changes on most scales of the State-Trait Anger Expression Inventory (STAXI) after eight weeks. To assess the longer-term efficacy of lamotrigine in therapy for aggression in women with BPD, this 18-month follow-up observation was carried out, in which patients (treated with lamotrigine: n = 18; former placebo group: n = 9) were tested every six months. According to the intent-to-treat principle, significant changes on all scales of the STAXI were observed in the lamotrigine-treated subjects. All subjects tolerated lamotrigine relatively well. Lamotrigine appears to be an effective and relatively safe agent in the longer-term treatment of aggression in women with BPD.
- [Show abstract] [Hide abstract] ABSTRACT: In a cross-sectional study, the authors investigated 40 female patients with fibromyalgia syndrome (FS) for the degree of alexithymia and parental bonding style. Alexithymia was assessed by the Toronto Alexithymia Scale-26; parental style by the FDEB (a German version of the Measure of Parental Style). In 15% of patients with FS, clinically significant alexithymia was found. Also, there was a positive association between the alexithymia scores (TAS total score) and "maternal abuse" and higher values in "paternal indifference," which predicted higher scores on "Difficulties identifying feelings" (TAS). The results of this study suggest that parental styles are associated with higher alexithymia scores.
- [Show abstract] [Hide abstract] ABSTRACT: Somatization symptoms are frequently associated with feelings of distress, and these features interact with the activity of cortisol. Clinical studies indicate that hypocortisolism is a biological marker of stress-related disorders (Heim et al., 2000; Ehlert et al., 2001). We have described an adrenocorticotropic hormone (ACTH) receptor promoter polymorphism (-2 CTC→CCC) within the transcription initiation site that leads to a lower ACTH sensitivity in normal individuals (Slawik et al., 2004), which is associated with a lower cortisol secretion (Reisch et al., 2005) and therefore may influence cortisol homeostasis under stress conditions. The aim of this cross-sectional study was therefore to investigate the prevalence of the -2 CTC→CCC ACTH receptor promoter polymorphism systematically in a group of patients with SFD (somatoform disorders). Blood samples of 42 patients (33 women, nine men with an age range of 18-63 years; median 40.5) who met International Classification of Diseases-10 diagnostic criteria for SFD were analyzed for the ACTH receptor promoter polymorphism as previously described (Slawik et al., 2004) and compared with male healthy control individuals (n=1.266 with an age range of 18-50). All patients (recruited from the Psychosomatic Outpatient Clinic) and healthy controls (recruited from blood donors) were German with a European genetic background. In SFD, 35 patients revealed the wild-type genotype (83%), six were heterozygous (14%) and one homozygous (2%) for the -2 CTC→CCC ACTH receptor promoter polymorphism. The prevalence of the polymorphism in 1266 unrelated healthy men was 80.2% for CTC/CTC, 19.0% for CTC/CCC, and 0.8% for CCC/CCC (genotypes were in Hardy-Weinberg equilibrium). The prevalence of the -2 CTC→CCC ACTH receptor promoter polymorphism in SFD did not differ from the normal healthy population (P=0.298). Additionally, we found only moderate depression severity scores (Hamilton Depression Rating Scale 14.0, SD=6.44; Beck Depression Inventory 18.6, SD=10.71) and no significant relationship between the carrier status of the -2 CTC→CCC ACTH receptor promoter polymorphism (wild type or heterozygous/homozygous) and the depression scores [Hamilton Depression Rating Scale (P=0.950, d.f.=40) and Beck Depression Inventory (P=0.934, d.f.=40)]. The hypocortisolism of stress-related disorders such as SFD described in recent studies (e.g. Heim et al., 2000) obviously can not be explained by a decreased adrenal responsiveness to ACTH resulting in lower cortisol secretion owing to the -2 CTC→CCC polymorphism within the transcription initiation site of the ACTH receptor gene. In summary, our results do not support an involvement of the -2 CTC→CCC ACTH receptor promoter polymorphism in SFD; further studies would be valuable to replicate our results.
- [Show abstract] [Hide abstract] ABSTRACT: This study examines the relationship between parental bonding, adult attachment, and alexithymia in patients with Somatoform Disorders (SFD). There are few empirical studies to support the clinical hypothesis that alexithymia may be due to disturbances in the early parent-child relationship. In a cross-sectional study, data from 76 patients with SFD were obtained, consisting of questionnaire measures of alexithymia (TAS scale), attachment style (BFKE), and also the German version of the MOPS (Measure of Parental Style), the FDEB scale for measuring perceived parental attitude. A higher than average prevalence of insecure attachment (n = 67, 88.2%) was found in our sample with SFD and a T-value of 54.3 (9.5) in the TAS total score, 22% reaching clinically significant alexithymia. Regression analyses demonstrated the relationship between the "ambivalent clinging" and "ambivalent withdrawing" attachment style and more marked alexithymia features. Furthermore, alexithymia was positively predicted by "indifference" in the relationship to the father, BDI, and Global severity index (SCL-90-R). The results of this study support the hypothesis that alexithymia is associated with perceived parental bonding and attachment style.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: Previous studies have suggested that somatoform disorders (SFD) might be associated with changes in the function of the central and autonomic nervous systems. The aim of this study was to examine the possible immunological differences between SFD and healthy controls. Methods: Twenty-four patients with SFD and 13 healthy individuals completed the psychological questionnaires to assess symptom reporting [Symptom Checklist-90 Revised (SCL-90-R)] and to diagnose for SFD [Screening for Somatoform Symptoms scale (SOMS-scale)]. Participants also provided a blood sample taken in the morning, which was analysed with an automated cell counter to determine the number of leucocytes per μl and with flow cytometry to determine lymphocyte subsets. Results: With the exception of a higher T4/T8 ratio in the patient group, which was mainly because of lower CD8 counts, there were no significant differences in the absolute number of lymphocytes (subsets) between patients with SFD and healthy subjects. A positive correlation between B-lymphocyte subsets (CD19+CD22+, CD19+CD5+, CD19+CD3−) to all scales of the SCL-90-R, except somatisation, were found in SFD. Additionally, a positive correlation was found in SFD between CD14+CD16+ monocytes and somatisation (0.573) on the SCL-90-R scale. Conclusion: These data indicate that patients with SFD have an enhanced humoral immunity as shown by increased B-cell numbers and furthermore an elevated T4/T8 ratio because of lower CD8 suppressor cells. Further studies will be required to determine whether these alterations in lymphocyte subsets are directly involved in the pathophysiology of SFD.
- [Show abstract] [Hide abstract] ABSTRACT: Only one controlled trial is known that employed aripiprazole for patients with borderline personality disorder (BPD). This 8-week trial found significant changes on most scales of the symptom checklist (SCL-90-R), Hamilton depression rating scale (HDRS), Hamilton anxiety rating scale (HARS), and on all scales of the state-trait anger expression inventory (STAXI). OBJECTIVES, MATERIALS, AND METHODS: To assess the long-term effectiveness of aripiprazole with multifaceted borderline symptomatology, this 18-month follow-up observation with biannual testing was carried out with the same patients from the previous trial (treated with 15-mg aripiprazole daily, n = 26, 21 female and 5 male patients; previous placebo group, n = 26, 22 female and 4 male patients). According to the intent-to-treat principle, significant changes on all scales of the SCL-90-R, HDRS, HARS, and STAXI were observed in the aripiprazole-treated subjects after 18 months. Aripiprazole appears to be an effective and relatively safe agent in the long-term treatment of patients with BPD.
- [Show abstract] [Hide abstract] ABSTRACT: The effectiveness of cabergoline in 50 men with psychogenic erectile dysfunction was investigated in a 4-month, randomized, placebo-controlled, double-blind study with validated psychological tests, and prolactin, follicle-stimulating hormone, luteinizing hormone and testosterone serum levels. Cabergoline treatment was well-tolerated and resulted in normalization of hormone levels in most cases. In the cabergoline-treated group, significant interactions between prolactin and testosterone serum concentrations were observed. Erectile function improved significantly. Sexual desire, orgasmic function, and the patient's and his partner's sexual satisfaction were also enhanced. Cabergoline may be an effective and safe alternative agent for men with psychogenic ED.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of the present study was to investigate if somatoform disorders (SFD) are associated with changes in the normal serum levels of important interleukins, and further, to establish if these changes are related to the presence and severity of alexithymia in patients with SFD. Twenty-four unmedicated patients who met the International Classification of Diseases (ICD-10) diagnostic criteria for SFD completed the psychological questionnaire to assess alexithymia (Toronto Alexithymia Scale), symptom reporting (SCL-90-R) and diagnostic criteria for SFD (Screening for Somatoform Symptoms scale). Serum concentrations of soluble interleukin 2 receptor alpha (sIL-2 Ralpha), IL-4, IL-6, IL-10 and IL-12 were determined in patients with SFD and in 9 healthy subjects. In patients with SFD, serum levels of IL-6 (p < 0.001), IL-10 (p = 0.047) and immunoglobulin E (p = 0.045) were significantly increased in comparison with healthy controls. Additionally, a negative correlation was observed between the level of alexithymia ('total' Toronto Alexithymia Scale score) and the serum levels of sIL-2 Ralpha (r = -0.538) in SFD. Taken together, these results suggest that SFD, with clinically significant alexithymia, are associated with a reduction in Th1-mediated immune function and an increase in the activation of the Th2 immune function, indicated by the augmented serum levels of IL-6 and IL-10 and elevated immunoglobulin E.
- [Show abstract] [Hide abstract] ABSTRACT: Religiosity and/or spirituality can be regarded as important elements in coping with life-threatening or other illnesses. In patients with "Somatoform Disorders" (SFD) the connection between religiosity and individual attachment styles with respect to attachment theory was investigated more closely. 76 patients aged 42,2 years (±9,9) were recruited for the interviews and questionnaires. The extent of the religious attitudes and practices was evaluated using the German version of "Systems of Belief Inventory" (SBI-15R-D); in addition, the BFKE scale (Bielefeld Clients' Expectations Questionnaire) was used to collect attachment styles. The predominant number of the patients with SFD is "insecurely" attached (88,18%); the remainder is "securely" attached (11,96%). The "avoiding cooperative" group of patients is more religious than the remaining attachment groups, and the more "ambivalent-clinging" the attachment style is, the more religious the patients are. There are therefore indications for a relationship between religiosity and attachment style in patients with SFD.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to examine whether bioenergetic exercises (BE) significantly influence the inpatient psychotherapeutic treatment results for Turkish immigrants with chronic somatoform disorders. In a 6-week randomized, prospective, controlled trial, we treated a sample of 128 Turkish patients: 64 were randomly assigned to BE and 64 participated in gymnastic exercises in lieu of BE. The Symptom Checklist (SCL-90-R) and State-Trait Anger Expression Inventory (STAXI) were employed. According to the intent-to-treat principle, the bioenergetic analysis group achieved significantly better treatment results on most of the SCL-90-R and STAXI scales. BE appears to improve symptoms of somatization, social insecurity, depressiveness, anxiety, and hostility in the inpatient therapy of subjects with chronic somatoform disorders. Reduction of the anger level and reduction in directing anger inwards, with a simultaneous increase of spontaneous outward emotional expression, could be expected.
- [Show abstract] [Hide abstract] ABSTRACT: This study was carried out to examine sociopsychopathological predictors of prospective observed suicide attempts in bulimic women purging type without comorbid major depression (BNG) at the time of study entry and in woman with major depression without comorbid eating disorder at the time of study entry (MDG). Data from 28 BNG (age 23.5 +/- 3.6) and 126 MDG women (age 33.4 +/- 5.1) who had attempted suicide during 12 months' monitoring were compared. A univariate comparison of the two groups revealed various differences. Analysis of risk factors for suicide attempts using stepwise logistic regression was conducted separately for each group. The derived logistic models showed that patients from the BNG group had a history of higher incidence of sexual abuse in childhood, as well as abuse of laxatives and illicit drugs; they also lacked orientation in life, felt lonely despite family and friends, tended to direct their anger outward, and were unable to relax. Sociopsychopathological risk factors for suicide attempts in the BNG and MDG appear to vary.
Article: Implementierung der multizentrischen Basisdokumentation CL-BaDo für den Konsiliarund Liaisondienst: Generierung von Daten für internes Qualitätsmanagement und Kostenkalkulation/ Implementation of the multi-center basis documentation CL-BaDo for conciliar and liaison services: Generating data for internal quality management and cost calculation
- [Show abstract] [Hide abstract] ABSTRACT: Aripiprazole is a relatively new atypical antipsychotic agent that has been successfully employed in therapy for schizophrenia and schizoaffective disorders. A few neuroleptics have been used in therapy for patients with borderline personality disorder, which is associated with severe psychopathological symptoms. Aripiprazole, however, has not yet been tested for this disorder, and the goal of this study was to determine whether aripiprazole is effective in the treatment of several domains of symptoms of borderline personality disorder. Subjects meeting criteria for the Structured Clinical Interview for DSM-III-R Personality Disorders for borderline personality disorder (43 women and 9 men) were randomly assigned in a 1:1 ratio to 15 mg/day of aripiprazole (N=26) or placebo (N=26) for 8 weeks. Primary outcome measures were changes in scores on the symptom checklist (SCL-90-R), the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), and the State-Trait Anger Expression Inventory and were assessed weekly. Side effects and self-injury were assessed with a nonvalidated questionnaire. According to the intent-to-treat principle, significant changes in scores on most scales of the SCL-90-R, the HAM-D, the HAM-A, and all scales of the State-Trait Anger Expression Inventory were observed in the subjects treated with aripiprazole after 8 weeks. Self-injury occurred in the groups. The reported side effects were headache, insomnia, nausea, numbness, constipation, and anxiety. Aripiprazole appears to be a safe and effective agent in the treatment of patients with borderline personality disorder.
- [Show abstract] [Hide abstract] ABSTRACT: Previous studies found that depressive symptoms and low functional self-efficacy are associated with the occurrence of disabling musculoskeletal pain, and diminished quality of life in elderly people. The target of this study was to consider the change in instrumental activities of daily living (IADL) disability and health related quality of life after integrative psychotherapeutic treatment program of depressive symptoms in senior female patients with musculoskeletal pain. In an 8-week outpatient-based, random, prospective, controlled trial, 36 female patients between 70 and 79 with a history of clinically evident musculoskeletal pain and afflicted with depressive symptoms, but who were able to bathe, walk, dress, and transferring inside the house were evaluated. The study was performed using the Center for Epidemiological Studies Depression Scale (CES-D), IADL, and the Health Survey (SF-36). In comparison with the untreated group, according to the intent-to-treat principle, significant changes on the CES-D (P < 0.01), IADL (P < 0.01), and all scales of SF-36 were observed after eight weeks in the treated subjects. The treatment of moderate depression with integrative psychotherapy may be efficacious in improving of IADL disability and health related quality of life in affected senior female patients with musculoskeletal pain.
- [Show abstract] [Hide abstract] ABSTRACT: Psychosomatic rehabilitation and the concluding social-medical assessment constitute a particular challenge. The aim of this study was to examine whether inpatient psychosomatic rehabilitation in the context of an integrated treatment concept, conducted in Turkish and German, is effective in the rehabilitation of Turkish migrant laborers, and what concluding socio-medical assessment results from this treatment. 195 Turkish patients--44 male and 151 female--received inpatient psychosomatic treatment for approximately 40 days. Sociodemographic, psychiatric and social-medical data were recorded, as well as Symptom Checklist (SCL-90-R) testing upon admission and discharge. A predominant number of patients were laborers, with a low level of primary education, who were afflicted with psychosocial problems and dissatisfaction with their workplace and who first came into psychosomatic treatment many years following the onset of their illness. Many of them had a clearly defined desire to retire. At the end of their admission, a significant improvement in almost all the scales of the SCL-R-90 was ascertained on the one hand, but on the other, adequate socio-medical results were hardly observed. The symptoms' improvement would confirm that the combination of service offerings in Turkish and German proved themselves. A portion of the patients (approx. 40 %) were classified subsequent to treatment as capable of working for 6 hours or more. Nevertheless, approximately approx. 75 % still sought to retire. Timely psychosomatic treatment could counteract chronification of the illness and the establishment of a steadfast desire to enter retirement, and consequently represent an improvement in the prognosis. Likewise, consistent psychosomatic training of physicians, as well as systematic prophylactic measures with the migrant laborers, should be considered.
Ludwig-Maximilian-University of Munich
München, Bavaria, Germany
- • Department of Psychiatry
- • Department of Internal Medicine II
Medical University of GrazGratz, Styria, Austria
Periyar Maniammai UniversityTanjor, Tamil Nadu, India