Occurrence and treatment of post-traumatic stress disorder in an elderly patient after a traffic accident.
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Accidents, Traffic↗
Biomedical subjects
Gereon Heuft
Publications and source records attributed to Gereon Heuft.
[Body dysmorphic disorder. Epidemiology, clinical symptoms, classification and differential treatment indications: an overview].
Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a relatively common disorder that consists of preoccupation with some imagined or slight defect in physical appearance. The preoccupation causes emotional distress and social impairment. Overvalued ideation and referential thinking are prevalent. BDD has a rich tradition in European psychiatry, but it first entered the official psychiatric nomenclature as a separate disorder in DSM-III-R in 1987. In the last 10 years it has received increasing empirical attention. BDD has been hypothesized to be related to obsessive-compulsive disorder (OCD) or may be conceptualized as hypochondriacal disorder. According to its body image disturbance it has been related to cenesthesia, eating disorders, and transsexualism. This paper presents the current level of awareness about BDD based on an analysis of the relevant literature. Empirical data are summarized and clinical signs are described. Varying therapies are critically reviewed.
Combined Modality Therapy↗
Clinical presentation and personality factors are predictors of the response to treatment in patients with functional dyspepsia; a randomized, double-blind placebo-controlled crossover study.
The role of psychological factors or symptom pattern for the response to treatment in patients with unexplained (functional) dyspepsia is unknown. We hypothesized that patients with reflux- and ulcer-like symptoms would be more likely to respond to acid-lowering therapy, while psychological disturbances would be associated with a less favorable response to treatment. Seventy-eight patients with a diagnosis of functional dyspepsia were recruited and 75 completed the trial. Patients were treated for 4 weeks in a double-blind, placebo-controlled crossover trial starting in random order with either active drug (ranitidine, 150 mg b.d.) or placebo. Every 7 days, medication was switched from active drug to placebo, or vice versa. At entry, patient characteristics were assessed utilizing a semistructured standardized interview and standardized questionnaires, and weekly intensity of symptoms was assessed utilizing a visual analogue scale. Patients with a greater reduction of the symptom score during active treatment and an overall reduction of the global symptom score by more than 50% at the end of the study period were categorized as responders. Logistic regression analysis was utilized to assess the influence of symptom type and presence of psychological disturbances on the treatment response. During treatment the symptom score decreased significantly, from 32.1 +/- 1.44 (SD) to 21.3 +/- 1.9 at the end of the trial (P < 0.001). Twenty of 75 were responders. High scores for somatization (OR, 3.6; 95% Cl, 1.2-11.4), anxiety (OR, 3.3; 95% Cl, 0.9-11.8), and reflux-like symptoms (OR, 5.3; 95% Cl, 1.7-16.7) were associated with response to treatment, while dysmotility-like symptoms were associated with an unfavorable response (OR, 0.3; 95% Cl, 0.1-0.9). Symptom pattern and psychological disturbances are independent predictors of treatment response. Patients with reflux-like symptoms and greater psychological disturbances are more likely to respond to an acid-lowering compound.
Adult↗
[Secondary prevention for police officers involved in job-related psychologically stressful or traumatic situations].
OBJECTIVES: Police officers are at high risk of being exposed to psychologically straining situations and potentially psychotraumatic experiences. In this article, such situations are exemplified and categorized, and the role and significance of secondary prevention following traumatic experiences is discussed. METHODS: From 1994 to 2003, 649 police officers received secondary prevention after being involved in a total of 250 potentially traumatic or psychologically stressful incidents. Psychological support was provided by teams of specially trained professionals in the acute phase after the incident following careful psychological evaluation. In a retrospective evaluation, the diagnoses obtained were analyzed with regard to sex and age and correlated with the severity of the incident. Three clusters of potentially traumatic situations were formed: (1) Employment of fire-arms with danger for the officer, (2) Standard situations including violence towards a third party, (3) Suicide or attempted suicide of a police officer. RESULTS: Police officers who experienced events assigned to cluster (1), comprising situations with considerable traumatic potential, had the highest incidence of posttraumatic stress disorder (PTSD) or other mental illness. Compared to male officers, females were more often diagnosed with other mental illness, whereas males had a higher incidence of PTSD. Cluster (2), which comprised situations of an officer's daily professional life, was not associated with an increased risk of mental illness. Officers were apparently capable of coping with situations considered psychologically straining for the general public without detectable evidence of a traumatic reaction. In cluster (3), which reflects the most dramatic interference with team relations, other forms of mental illness were diagnosed at a higher incidence.
Adult↗
[Comorbidity of mental disorders in the German G-DRG system -- effect on length of stay and revenue at a university hospital].
OBJECTIVES: The effect of comorbid mental disorders on the length of stay and revenue in a DRG system was investigated. METHODS: For 33,189 cases of an university hospital (year 2002) the revenue based on a fictitious base rate was calculated, at first with and then without inclusion of diagnosed comorbid mental disorders. Furthermore, the effect of the latter on the length of stay was examined. RESULTS: Renunciation of diagnoses of mental disorders lead to an different DRG grouping in 7.9 % of cases and to a reduction in revenues of about 170.000. Minimal influence of comorbid mental disorders on the length of stay (R2 = 0.02) could be detected for single diagnostic groups. CONCLUSIONS: The lacking influence of comorbid mental disorders on the length of stay in a university hospital is mainly determined by the limited period of inpatient treatment and by the low frequency of diagnosed mental disorders. Therefore, a psychosocial consultation-liaison service is of major importance to guarantee the diagnosis and treatment of a comorbid mental (process quality) disorder and to guarantee adequate revenues in the G-DRG system (quality of structure).
Adult↗
[Actual situation: Psychosomatic and psychotherapeutic medicine goes DRG].
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Cost Control↗
[Psychosomatic and psychotherapeutic medicine goes DRG -Procedure-catalog OPS-301 2.1 as a first step].
To demonstrate the repercussions for Psychosomatic and Psychotherapeutic Medicine of the politically motivated decision to introduce case mix funding for inpatient treatment in Germany. Description of the development of an appropriate code list of procedures for Psychosomatic and Psychotherapeutic Medicine within the DRG-System. The code list OPS-301 which was valid in 2001 had no appropriate procedures for Psychosomatic and Psychotherapeutic Medicine. The scientific societies therefore had to develop possibilities for coding psychosomatic-psychotherapeutic procedures in the new OPS-301 2.1 which is valid since January 2002. This was achieved through the formulation of so-called complex codes, which are presented together with first coding tips. There are further tasks with risks and potential benefits which have to be accomplished after establishing these complex codes.
Cost-Benefit Analysis↗
[Psychic impairment in psychosomatic and psychiatric quality assessment: global assessment of functioning scale (GAF) vs. impairment score (IS)].
OBJECTIVES: The Global Assessment of Functioning Scale (GAF) and the Impairment-Score (IS) are important instruments for Quality Assessment. There are only few studies examining the quality of statistical power of the GAF-Scale indicating problems in construct validity and no larger studies for the IS. METHODS: For a sample of 263 patients the Psy-BaDo and an OPD-Rating were completed. RESULTS: Though the distribution of both scales show large range, the proportion of explained variance is 58 %. This proportion can be increased to 68 % for the IS by including the OPD-Ratings. The GAF-Scale in contrast is not associated with the OPD-Ratings. CONCLUSIONS: The results indicate, that the combination of both scales is necessary to represent the whole variance of psychic impairment (ICD-10 Chapter F & Z). In addition the valid rating of both scales is very difficult for patients with somatic disorders and somato-psychic problems.
Activities of Daily Living↗
[On the effects of psychoanalytic oriented psychotherapy - an inpatient multicenter study]
Whereas the efficacy of inpatient treatment in socalled psychosomatic rehabilitation clinics in Germany has been well researched and documented, studies involving large samples on the efficacy of inpatient treatment in acute hospitals are lacking. A multicentered retrospective study involving clinics for psychotherapy at three separate universities was conducted on a sample of n=495. The patients were treated on an inpatient basis between April 1990 and July 1998 in one of the clinics. The predominant approach to treatment of these clinics was psychodynamic. Other approaches such as behavioral therapy are integrated. In addition to sociodemographic variables clinical data (SCL-90-R, IIP, BSS, ICD-Diagnosis) at admission and discharge were collected. A follow-up study was not conducted. With an average effect size of 0.84 in terms of clinical scales the results demonstrate good efficacy of inpatient treatment. Effect sizes were high on the depression, obsessive-compulsive and anxiety scale of the SCL-90-R, and were low on the phobia subscale. By self report 55% of all patients indicated they had markedly improved, 22% indicated no change and 6% stated they were worse. 17% of all patients were below the chosen cut-off point of the GSI. Patients with a low level of education took benefit as well from the offered therapy. There was no clear relationship between effect size and length of hospital stay. This may be due to the particular setting of a university clinic.
Journal Article↗
What influences self-perception of health in the elderly? The role of objective health condition, subjective well-being and sense of coherence.
The study examines in what way objective health-related variables interfere with psychic health and personality factors in explaining self-perception of health in the elderly. Two hundred and sixty-one patients aged 60 and older of an internal medicine hospital previously examined between 1994 and 1997 were once more contacted five years later. One hundred and sixty-four patients could not be included in the present investigation because of death, dementia, or severe physical illness. Of the 97 patients eligible for this second investigation, 74 agreed to participate. They were investigated extensively by means of psychometric scales and diagnostic interviews. A positive selection effect could be found for the sample of the present investigation with regard to age and health-related variables. Subjective evaluation of health correlated highly with the self-evaluation scales that recorded subjective well-being (life satisfaction, anxiety, and depression), and with the sense of coherence, but not substantially with objective health-related variables. A backward regression resulted in an adjusted R2 = 0.33 for the three retained variables "subjective physical complaints", "sense of coherence" and "self-evaluated depression" which rendered the same variance clarification of subjective health as did the model including all variables. Since the elderly represent the majority of patients treated in general hospitals and as subjective health and subjective physical complaints influence frequency of medical consultations and health care utilization, this is an important issue for consultation-liaison-psychiatry and health policy.
Activities of Daily Living↗
Ageing styles: subjective well-being and somatic complaints in inpatients aged >/=60 years.
BACKGROUND: Recent gerontological research shows a high variability in the elderly population. The aim of the present study is to investigate by means of cluster analysis, as to whether different 'ageing styles' can be identified in a sample of cognitively not impaired older persons, and to assess discrepancies between self-rated and expert-rated psychological and physical health. METHOD: 243 patients aged 60 years and older in a general hospital were investigated using a clinical psychiatric interview, expert ratings, and self-report scales after extensive internal medical diagnostic evaluation. RESULTS: Five clusters, representing significantly different 'ageing styles' with regard to subjective well-being and subjective physical complaints, could be identified. Two clusters, which together constituted 57% of the sample, represented quite positive and desirable ageing styles. In two clusters (altogether 23% of the sample), there was a discrepancy between medical findings and subjective physical complaints. CONCLUSIONS: These findings support the notion of high variability in the elderly and the existence of subgroups, which show a discrepancy between subjective assessment of well-being and expert assessment of psychological and physical health and impairment. The recording of subjectively perceived physical complaints should, therefore, be part of the evaluation of older peoples' subjective well-being.
Activities of Daily Living↗
Subjective body complaints as an indicator of somatization in elderly patients.
The authors examined the correlation of subjective body complaints (measured by the Giessen Subjective Complaints List) with sociodemographic data, objective health measures, measures of subjective well-being, and clinicians' ratings of somatization and psychological impairment in 251 cognitively unimpaired general hospital inpatients aged >/=60 years. The level of subjective body complaints correlated most highly with self-assessed life satisfaction and age-related changes and with the clinicians' rating of somatization. The results suggest that the level of subjective body complaints is determined by subjective well-being rather than by objective health measures, and thus subjective body complaints may be an indicator of somatization in elderly inpatients.
Activities of Daily Living↗