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Biomedical subjects

C E Scheidt

Publications and source records attributed to C E Scheidt.

12 recordsLinked to original sources
PubMed2000

[Somatisizing patients. Concrete recommendations for a stepwise therapy in general practice].

Patients with physical symptoms but no detectable organic substrate often present a challenge for the family doctor. The therapeutic approach discussed herein focuses on the development of a psychosomatic model of the problem. In this step-by-step approach, the patient's subjective understanding of, and attitude towards, his illness and its treatment are established, alternative psychosomatic models of disease based on a consideration of psychophysiological interactions are worked out jointly with the patient, and, finally, thought is given to the current complaints within the context of the patient's personality and life situation. The basis for successful treatment is an empathic and sound doctor-patient relationship based on trust that gives the patient the feeling that he and his problem are being taken seriously. The prerequisite for the use of such a program is appropriate training in basic psychosomatic care.

Aged↗
PubMed1999

Alexithymia and attachment representation in idiopathic spasmodic torticollis.

We investigated alexithymia and the mental representation of attachment in idiopathic spasmodic torticollis (IST). It was hypothesized a) that alexithymia in IST is more prevalent than in a nonclinical control group and b) that significant correlations emerge between alexithymia and a dismissing attachment representation. Twenty patients with IST and 20 healthy controls matched for age and sex were administered the Toronto Alexithymia Scale (TAS-20) and the Adult Attachment Interview (AAI). Attachment was classified using the Attachment Interview Q-sort. IST patients scored significantly higher on the measure of alexithymia than subjects in the comparison group. In IST a dismissing attachment representation was significantly more frequent than in the control group. Across the total sample, externally oriented thinking correlated positively with dismissing attachment, and both externally oriented thinking and difficulty communicating feelings (two of the three subscales of the TAS-20) correlated inversely with secure attachment. Alexithymia is more prevalent in IST than in normals. As was hypothesized, alexithymia in adults is significantly interrelated with the mental representation of attachment.

Adult↗
PubMed1999

[Not Available].

Theoretical issues and research emphasis within the field of attachment theory have shifted from attachment behavior "to the level of representation" (Bretherton, 1985) since the middle of the 80ies. The paper presents an overview on basic assumptions, research methodology and empirical findings in the field of attachment research. Four issues are addressed, which are relevant for psychosomatic research. These concern: (1) The prevalence of insecure attachment representation in psychosomatic disorders; (2) the association between insecure attachment representation and an increased psychophysiological reactivity; (3) the potential link between attachment and affect regulation and (4) the question, whether the classification of attachment representations may increase our understanding of specific aspects of illness behavior in psychosomatic conditions such as somatoform disorders.

Affect regulation↗
PubMed1998

[Psychosomatic aspects of idiopathic spasmodic torticollis. Results of a multicenter study].

Idiopathic spasmodic torticollis (IST) is one of the most frequent dystonic movement disorders. Its classification as a focal dystonia, as well as its treatment with botulinum toxin resulted in groups of patients being regularly seen by neurologic specialists. In a multicentre study, we investigated psychosocial changes, coping and psychopathology, and their interrelations with signs, symptoms and course. 256 patients were included in the study (59.3% women, 40.7% men). The mean age was 49.1 years. Rotating torticollis occurred more often than latero-retrocollis and antero-retrocollis. A family history of IST was seen in 3.1% of the total sample. 34% of the patients had additional dystonic symptoms. Most frequently, these affected the upper extremities (13%), less often the legs. 19.1% of the patients had experienced a period of complete remission. The General Symptom Index of the SCL 90-R in 27% of the patients ranged above the double standard deviation of the normal controls, indicating a clinically significant psychopathology.

Adaptation, Psychological↗
PubMed1996

Relative absence of psychopathology in benign essential blepharospasm and hemifacial spasm.

We report on the psychopathology and illness-related changes of life in patients with benign essential blepharospasm (BEB) or hemifacial spasm (HFS). Fifty-six patients with BEB and 40 patients with HFS completed the SCL 90R, a screening instrument for psychiatric symptomatology, and the Freiburg Questionnaire for Dystonia (FQD), a questionnaire about psychosocial changes in subjects with movement disorders. In both BEB and HFS patients, the mean scores on all but one subscale of the SCL 90R remained within the double standard deviation of normal. In comparing BEB to HFS patients in illness-related changes of life, BEB patients were more severely disabled in all areas of life examined. Psychological distress in BEB, but not in HFS, correlated with physical disability and in particular with impairment of vision.

Analysis of Variance↗
PubMed1996

[Diagnosis, symptoms and follow-up of psychogenic tremor].

A total of 21 patients with psychogenic tremor (PT) were asked to take part in a neurologic and psychosomatic assessment; for 17 patients follow-up information was also recorded. Women out-numbered men in the sample. In the majority of patients the tremor was associated with a variety of other conversion symptoms. The clinical picture of the tremor varied. After beginning exclusively in the extremities, it tended to spread to other parts of the body. Other psychopathology (depression and histrionic personality disorder) existed in almost a third of the sample. Many patients had retired from professional life, or planned to do so in the near future, because of PT. At follow up the initial diagnosis was confirmed in all patients although in some patients additional physical illness had developed during the follow-up period. When neurological and psychiatric/psychosomatic criteria are applied the diagnosis of PT can be established reliably. Studies that have questioned the validity of the conversion concept on the basis of frequent misdiagnoses may indicate problems in the diagnostic procedure rather than an invalid theoretical construct.

Adult↗
PubMed1995

[Subgroups of torticollis spasmodicus from the psychosomatic viewpoint. Results of a cluster analysis of 144 cases. German Study Group of Dystonia Research].

The question of subgroups in idiopathic spasmodic torticollis, which has been discussed in earlier studies in order to define etiologically heterogeneous patient populations has lost some of its relevance since with the injection of botulinum toxin an effective treatment is available. However, psychosocial distress is linked with spasmodic torticollis in a substantial number of patients. In order to define criteria for psychosocial interventions in addition to the treatment with botulinum toxin, a cluster analysis was carried out to identify high-risk populations in terms of psychological and social distress. Five subgroups were defined on the basis of eight variables. Two of these five groups, one group with rotational torticollis and one with laterocollis, emerged as particularly distressed by their physical complaints, the effects of their illness on various areas of life and in terms of psychological functioning. The consistency of the subgroups was tested and statistically confirmed by analysis of variance. In a cross-validation 83.02% of the ungrouped cases were predicted correctly. The authors suggest that the evaluation of psychological and social aspects of the condition should be part of the neurological assessment in order to offer appropriate support to patients, who reveal a high degree of psychological distress.

Adaptation, Psychological↗
PubMed1995

[Clinical and psychometric findings in spasmodic torticollis].

In a previous study screening for psychopathological symptoms in a sample of 256 patients with spasmodic torticollis had resulted in 27% of patients, whose mean score of the GSI of the SCL-90-R was above the double standard deviation of the control group of normals (Scheidt et al. 1994). In this study the self-reported psychopathology of a subsample of 19 TS patients was controlled for its agreement with a clinical assessment in a psychiatric interview. The results of the study confirm the validity of the SCL-90-R as a screening instrument for psychological distress and psychopathology. However a tendency for social desirability in a subgroup of patients might lead to underestimate the degree of psychological distress in this patient group and might als account for some of the discrepant findings concerning psychological distress and psychopathology in TS in former studies. Furthermore the clinical assessment revealed a high psychiatric and psychosomatic morbidity prior to the onset of the spasmodic torticollis as well as a high frequency of traumatic life events (e.g. bereavement) in the patients premorbid history. In addition to coping with a crippling neurological condition concurrent psychopathology in TS therefore should be considered also in terms of the individuals premorbid psychological vulnerability.

Adaptation, Psychological↗
PubMed1992

[Psychodynamic aspects of coping with illness in stroke--experiences with a psychotherapy group].

The authors describe their experience of a group--psychotherapy with stroke patients during the phase of inpatient neurological rehabilitation. The process of coping in stroke patients shows similarities with grief reactions following the loss of important objects. But it is usually complicated by the fact that the physical injury is experienced as a narcissistic trauma resulting in low self--esteem and in feelings of anger and despair. Psychotherapeutic interventions can help to deal with such negative affects and should facilitate a mourning process, which is inevitable if adaptation to a life with a physical handicap should succeed.

Activities of Daily Living↗
PubMedDate not supplied

Attachment representation and cortisol response to the adult attachment interview in idiopathic spasmodic torticollis.

OBJECTIVE: The study investigates individual differences in the mental representation of attachment and their impact on the cortisol response to psychosocial stress in idiopathic spasmodic torticollis (IST). It was hypothesized (a) that in IST insecure attachment is more prevalent than in a non-clinical control group and (b) that subjects with dismissing attachment respond with higher physiological arousal to a specific stimulus activating the attachment behavioural system than subjects with secure attachment. METHOD: 20 patients with IST and 20 healthy controls matched for age and sex underwent the Adult Attachment Interview, an hour-long, semiclinical interview on attachment experiences. During the interview salivary cortisol levels were monitored. The subjects' mental state with regard to attachment was classified using the attachment Q-sort method. Anxiety and depression were measured as potential covariates of the adrenocortical stress response. RESULTS: Compared to the non-clinical group, dismissing attachment was strongly overrepresented in IST. In IST, but not in the healthy control group, dismissing attachment correlated with an elevated cortisol response to the interview. CONCLUSION: In clinical, but not in non-clinical samples dismissing attachment may be associated with increased vulnerability to psychosocial stress. The factors contributing to this interaction are not yet fully elucidated.

Adult↗
PubMedDate not supplied

[Psychotherapy of somatoform pain disorders in the elderly].

This article focuses on somatoform pain disorders in elderly patients. Defined as a variant of the somatoform disorders, somatoform pain represents a disorder characterized by significant, physically experienced pain that is not (fully) explained by a medical condition. Although epidemiological data are sparse, the prevalence of somatoform pain disorders appears to decline with aging. Psychological factors are assumed to have an important role in the onset, severity, and maintenance of somatoform pain. In this article, two case reports are presented in order to illustrate the phenomenon that earlier pain experiences, e.g., in the context of a physical disorder or in the context of traumatic events, may "pave the way" for somatoform pain syndromes. Later acute mental stress or psychological conflicts may then precipitate the onset of somatoform pain. With respect to therapy, one should consider that patients with somatoform pain experience and interprete their suffering as a physical disorder. When applying psychotherapy to patients with somatoform pain disorders the therapist has to recognize and to appreciate eventual previous pain experiences which may have "paved the way" for the present disorder. Only after having established a therapeutic relationship can one try to interest the patient in the individual emotional and cognitive aspects that may underly the disorder. In addition to depressive feelings and feelings of guilt, grief about the loss of bodily functions may be of special significance for the onset and maintenance of somatoform pain disorders in elderly persons.

Activities of Daily Living↗