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Biomedical subjects

H Faller

Publications and source records attributed to H Faller.

At least 19 recordsLinked to original sources
PubMed2002

Expression of tumor necrosis factor-alpha and interferon-gamma mRNA in blood cells correlates with depression scores during an acute attack in patients with multiple sclerosis.

Depression is a common problem in multiple sclerosis (MS) and affects about 50% of MS patients. Since a dysregulation of cytokine levels has been implicated in the pathogenesis of MS and alterations in cytokine serum levels have been found in depressive illness, we examined the relationship between depressive symptoms, cytokine mRNA expression levels of Th1-type and Th2-type cytokines and neurological disability among early diagnosed MS patients in a prospective study. Sixteen patients with clinically or laboratory supported MS were assessed using the Beck Depression Inventory (BDI) and the Kurtzke Expanded Disability Status Scale (EDSS). Cytokine mRNA in whole blood was serially determined by a new quantitative polymerase chain reaction (PCR) method. BDI sum scores (2,9 fold) and the expression levels of tumor necrosis factor-alpha (TNF-alpha; 4 fold), interferon-gamma (IFN-gamma; 4,6 fold) and interleukin-10 (IL-10; 6,1 fold) mRNA were increased in MS patients during an acute attack compared to age and sex matched healthy controls. We detected a significant positive correlation between TNF-alpha (r=0.55) and interferon-gamma (r=0.54) mRNA expression and the BDI sum scores during an acute attack in MS patients. At follow-up after 3-6 months, only TNF-alpha mRNA expression was correlated with BDI sum scores (r=0.62 resp. r=0.31). No correlation of the BDI sum scores with Th2-type cytokine mRNA expression for interleukin-4 (IL-4) and interleukin-10 (IL-10) or with the extent of neurological disability was observed. The possible contribution of Th1-type cytokines to the development of depression in MS is discussed.

Adult↗
PubMed2002

Paroxetine for the treatment of interferon-alpha-induced depression in chronic hepatitis C.

BACKGROUND: Psychiatric side-effects may require dose reduction or premature discontinuation of interferon therapy in chronic hepatitis C. New strategies are needed in order to prevent the premature termination of interferon therapy. AIM: To evaluate prospectively the efficacy and tolerability of antidepressant therapy (paroxetine, a selective serotonin reuptake inhibitor) in patients with chronic hepatitis C treated with interferon-alpha who have developed interferon-induced major depression. METHODS: A sub-group of 14 individuals from 121 consecutively treated hepatitis C patients developed substance-induced major depression without suicidal ideation during interferon-alpha treatment. The individuals in this sub-group received paroxetine after the occurrence of depression (20 mg daily until termination of interferon therapy). Diagnostic scores for depression (and anger-hostility) were obtained in a repeated measures design (Hospital Anxiety and Depression Scale and Symptom Checklist 90 Items Revised). RESULTS: Eleven of the 14 patients (78.6%) with interferon-induced major depression were able to complete interferon-alpha therapy as scheduled under concomitant paroxetine treatment (three dropouts: insufficient improvement of depression, occurrence of epileptic seizures, paroxetine-induced nausea/dizziness). Within 4 weeks after the start of paroxetine medication, depression scores declined significantly in all patients. CONCLUSIONS: Our data suggest that concomitant therapy with paroxetine is an effective way to treat interferon-induced depression in patients with chronic hepatitis C.

Adolescent↗
PubMed2001

Compliance with therapy in patients with chronic hepatitis C: associations with psychiatric symptoms, interpersonal problems, and mode of acquisition.

Tolerance of interferon-a therapy for hepatitis C is often poor and medication is expensive. Compliance with diagnostic procedures and, even more important, with medical treatment is obviously critical to minimize the rate of dropouts and to maximize cost efficiency. Moreover, a good concordance with scheduled follow-ups is important for early recognition and treatment of interferon-associated side effects. Therefore, we investigated psychiatric symptoms, interpersonal problems, different modes of acquisition, and sociodemographic factors in HCV-infected patients as possible predictor variables of good versus poor compliance. In a longitudinal study, 74 patients with chronic hepatitis C (CHC) who fulfilled the criteria for treatment with interferon (IFN)-alpha-2b with or without ribavirin were investigated prospectively to identify those at risk for poor compliance during IFN medication. To assess predictive factors, we used both IIP-C (Inventory of Interpersonal Problems) and SCL-90-R (Symptom Check List 90 Items Revised) as psychometric instruments. Sociodemographic and somatic variables as well as compliance during IFN therapy were also evaluated. Poor compliance before or during medication was demonstrated by 23% (N = 17) of HCV patients. Sociodemographic factors and mode of acquisition, particularly former intravenous drug (IVD) abuse were not significantly linked with compliance. Logistic regression analysis demonstrated that the subgroup of patients with compliance problems was best identified by both pretherapeutic psychiatric symptoms and interpersonal problems. Predictive value was best and significant for anger-hostility (P = 0.009), intrusive (P = 0.014), depression (P = 0.015), and phobic anxiety (P = 0.049). Adopting this statistical prediction model, sensitivity was 47.1%, but specificity reached 98.3%. In total, 86.5% of cases were classified correctly. In situations of unclear indication for IFN therapy, psychological variables assessment of before the beginning of treatment may represent an additional decision-making factor.

Adolescent↗
PubMed2001

[Causal attribution and personality in psychotherapy patients].

The present study addressed the relationship between patients' causal attributions of their disorders on one hand and their personality traits on the other. The investigation was based on the self-reports of 197 psychotherapy patients who presented at a university outpatient department for diagnostic evaluation. Personality traits were measured using the Giessen-Test (Beckmann et al., 1991), causal attributions were assessed by a check list (Faller 1997). Intrapsychic causal factors were rated highest; after those, interpersonal and social factors followed next, while somatic factors were judged to be least important. Psychosocial attributions showed strong correlations with the self-report of depressed mood in the Giessen-Test. Similar relations were found with other personality traits such as low ratings of social resonance, low openness, and low social potency. The reported interrelations suggest that psychological symptoms, personality and causal atttributions are closely intertwined.

Adolescent↗
PubMed2000

[Patient expectations regarding methods and outcomes of their rehabilitation--a controlled study of back pain- and cancer patients].

Although patient expectations are important factors of the success of rehabilitation, they have not yet received much attention in research. In the present cross-sectional study, n = 248 rehabilitation patients, n = 160 suffering from chronic back pain and n = 88 suffering from oncological diseases (breast cancer, cervical cancer, ovarian cancer, colorectal cancer), were assessed at the time of admission to a rehabilitation clinic, using a newly developed self-report questionnaire to evaluate their expectations regarding the process and outcome of their rehabilitation. Results show on an item level that non-specific process expectations such as balneophysical treatments or features of the surroundings of the clinic were most prevailing. Across both diagnostic groups, common goals of rehabilitation such as reduction of complaints, physical fitness and recreation scored highest. On the basis of factor analysis, 10 scales of process expectations were constructed: medical attention, physical training, vocational counselling, balneophysical treatment, health information, stress management training, support groups, relief from the strains of everyday life, alternative medicine, and pleasant surroundings. Nine dimensions of outcome expectations were detected: ability for work, physical fitness, reduction of complaints, behaviour change, reduction of body weight, positive body feeling, vitality, enjoyment of life, and social contact. In the univariate analysis, orthopaedical patients scored higher on balneophysical treatments and vocational counselling (process expectations) as well as reduction of complaints and ability for work (outcome expectations). However, there were effects of age, gender and working status, too. Thus these differences between diagnostic groups turned out to be nonsignificant after controlling for the effects of age, gender, and working status. On the other hand, some effects of the medical condition had been hidden in the univariate comparison and were only revealed when adjusting for the moderator variables. Those differences show that oncological patients had higher expectations than back pain patients. Patients' expectations were correlated with functional status and, to a lesser degree, emotional distress and locus of control. To conclude, our study demonstrated that medical condition, sociodemographic factors, working status and functional capacity are important determinants of patient expectations regarding the process and outcome of rehabilitation.

Adaptation, Psychological↗
PubMed2000

[Therapeutic goals and indications: psychotherapy patient's self-reports during diagnostic assessment].

Although individual therapeutic goals are considered to be important factors motivating patients to engage in therapeutic work, they have gained little attention in empirical research. In the present study, patients were given a questionnaire containing 24 therapeutic goals which could be rated according to their subjective relevance on a 5-point scale. N = 152 patients (mean age 34.5 years, 59.2% female) who presented at a university psychotherapy outpatient department to attend a diagnostic interview participated in the study. "To solve my problems" and "to get relief from my complaints" were the goals that were rated as most important. Goals pertaining to mental health such as more contentness and calmness, self-assertion and insight scored high, too. Three rational scales were constructed: 1. insight, 2. sociability, and 3. self-assertion. These scales were correlated with both patients' causal attributions and therapy expectations in plausible ways. However, the general strength of intercorrelations point of the conception patients goals were not very succinct at the time of the intake interview. Indication groups regarding specific therapeutic measures did not differ with respect to therapy goals. Only the general decision whether to recommend a psychotherapeutic intervention or not seemed to be influenced by patients' therapeutic aims.

Assertiveness↗
PubMed2000

[Not Available].

Although treatment selection in psychotherapy can be conceptualized as an interactive process, as yet there is few empirical research that aimed at addressing the significance of therapists' emotional reactions to their patients when selecting appropriate psychotherapeutic treatments. The present naturalistic-observational cross-sectional study investigates therapists' countertransference which was assessed after the completion of the intake interview. 13 psychotherapists rated their countertransference feelings regarding 237 patients who presented at a psychotherapy outpatient university department, using a 17-items feeling word checklist. By means of factor analysis, three dimensions of the countertransference ratings could be found: 1. sympathy; 2. helpfulness; 3. anger. Clusteranalytically, patients could be assigned to four groups that are characterized by specific countertransference patterns: 1. positive countertranference (n = 82); 2. weak countertransference (n=124); 3. ambivalent countertransference (n=16); and 4. negative countertransference (n=13). The frequencies of both diagnostic categories and selected treatments proved to differ between the clusters. In the positive countertransference cluster, patients with depressive disorders were more frequent and patients with somatoform disorders less frequent. In the positive countertransference cluster, the indication of cognitive-behavioral therapy was especially frequent. Regarding the combination of positive countertransference and selection of cognitive treatment, the result of a previous study could be replicated. This finding proved to reflect different countertransference attitudes and indication preferences of therapists with different therapeutic philosophy orientations (psychodynamic vs. cognitive-behavioral).

Countertransference↗
PubMed2000

Simultaneous interdisciplinary counseling in German breast/ovarian cancer families: first experiences with patient perceptions, surveillance behavior and acceptance of genetic testing.

As part of a multicenter study supported by the German Mildred Scheel foundation we have established an interdisciplinary counseling setting for members of breast and/or ovarian cancer families. We offer simultaneous counseling by a team consisting of a geneticist, a gynecologist and a psycho-oncologist. Here we describe our counseling protocol and our first short-term experience with this interdisciplinary approach. Preliminary data on patient perceptions and behaviors in the context of DNA testing are reported. Overall, our counseling approach was perceived as beneficial both by the counselors and the consultants. A marked overestimation of the risk to develop breast and/or ovarian cancer was noted in the group of unaffected individuals from medium to low risk breast cancer families in contrast to an appropriate risk perception in members from high risk families. All participants shared many of the same expectations about genetic testing and counseling and appeared to base their decision-making about testing on the risk classification given by the genetic counselor. The reported participation in gynecological cancer prevention programs was high in all families at risk, but was less sufficient in unaffected as compared to affected persons. Although current data on BRCA1/BRCA2 mutation analyses render testing in medium to low risk individuals questionable, our findings emphasize the importance of genetic counseling and education in all risk categories of breast and/or ovarian cancer families.

Adult↗
PubMed1999

Coping, distress, and survival among patients with lung cancer.

BACKGROUND: This study addresses the question of whether coping and emotional state are predictors of survival among patients with lung cancer. The hypotheses were (1) active coping is linked with longer survival time and (2) depressive coping, emotional distress, and depression are linked with shorter survival. METHODS: The study was based on a sample of 103 patients who were investigated after their diagnosis and before the beginning of primary treatment. The psychological variables were assessed by means of self-reports and interviewer ratings. After follow-up of 7 to 8 years, 92 patients had died; survival data were censored for the remaining 11 patients. The prediction of the survival time was performed by the Cox regression, while adjusting for biomedical risk factors (tumor stage, histological classification, and Karnofsky performance status). RESULTS: The self-reported depressive coping (P = .007) and the interviewer-rated emotional distress (P = .04) were significantly associated with shorter survival, independent of the influence of the biomedical prognostic factors. CONCLUSIONS: Both coping and emotional distress had a statistically independent effect on survival among patients with lung cancer. However, the naturalistic design of the study does not allow for any causal interpretation. Thus, the nature of this relationship warrants further investigation.

Adaptation, Psychological↗
PubMed1998

[Follow-up of myasthenia gravis. Results of a longitudinal study of the significance of psychosocial predictors].

Forty-two patients suffering from myasthenia gravis were examined in a longitudinal study design. The aim of the study was to investigate possible psychosocial predictors for the course of the disease. At the time of the first examination (T1) the diagnosis myasthenia gravis had been established for no longer than 1 year. Two further examinations were done at 6 months (T2) and 18 months (T3) after T1. Methods consisted of a personality questionnaire (FPI), a coping questionnaire (FKV), an assessment of neurotic symptoms by interviewers (PSKB) and an assessment of the doctor-patient relationship by the attending physicians. Two different severity scores (Oosterhuis Index, Myasthenia Score) served as criteria for the course of the disease. There was no connection between the course of myasthenia gravis and neurotic symptoms like anxiety or depression and the quality of the doctor-patient relationship (both assessed at T1). Also demographic data were independent from the development of severity scores. The personality factor extraversion was associated with a positive course of the disease, aggressiveness and worrying about health with a negative one. Among the coping behaviors religiousness and looking for sense were associated with a favorable course but that was shown only regarding the Oosterhuis Index and not the Myasthenia Score. As several T1 personality factors were predictive for the severity scores at T3, these results may suggest a causal influence of personality factors on the severity of the illness. Whether or not this relationship is actually in operation, however, remains ellusive. Further studies using an experimental design are needed to strengthen this hypothesis.

Adaptation, Psychological↗
PubMed1998

[Introduction of the Bavarian Scientific Rehabilitation Group].

As a part of the Rehabilitation Research Programme of both the Ministry for Education, Science, Research and Technology and the German Pension Insurance, the Rehabilitation Research Network of Bavaria has begun its work after having completed a planning phase of three years. Under the heading entitled "Patients in Rehabilitation" physical, psychological and social consequences of chronic diseases are addressed from a bio-psycho-social point of view. The network contains ten research projects which are located in different university institutions and rehabilitation clinics all over Bavaria. These projects can be assigned to three thematic clusters: diagnostical and predictor studies; evaluation of treatments; interface problems in rehabilitation. The interventions to be evaluated are aimed at strengthening patients' coping abilities. Wherever feasable, randomized controlled studies are performed. Both economical and gender-specific effects are investigated. A central facility for coordination and methodological consultation was implemented at the University of Würzburg. The network has the objective of both improving the quality of rehabilitation research and education and increasing the resources of institutions doing rehabilitation research in Bavaria.

Forecasting↗
PubMed1998

[Education in psychosomatic medicine and psychotherapy specialty: evaluation by students].

In the context of evaluation, experiences, attitudes, expectations and assessments concerning teaching psychosomatic medicine and psychotherapy were examined. For that purpose students of the winter term 1993/94 were given a questionnaire before and after the practical course. The students had little experience with the subject. They described low expectations regarding the training. However, they showed a very positive attitude towards the subject. After the course, they judged the training positively. In particular, the affective-subjective contents, considered as being typical for the subject, correlated with positive judgements of the teaching. Thus, in may be concluded that these aspects may be conveyed to the students by means of a Balint-like method of teaching and that these aspects are accepted by the students.

Adult↗
PubMed1998

[Problems and goals of psychotherapy patients. A qualitative-content analytic study of patient statements at initial assessment].

The present paper has the objective of demonstrating the content-analytical assessment of problems reported by the patient and of his expectations in respect of psychotherapeutic treatment. In this approach of qualitative research, the interpretation process is split up into several steps which can be tested with regard to their adequacy to the material. This reduces the range of subjective interpretations. The development of the analysis of content is described in detail. First of all, a system of categories was outlined on the basis of patients' Nos. 1-40. This system was then used to rate the texts Nos. 41-80 and modified. After that, the revised version was applied to rate the texts Nos. 81-120, and so on. As can be shown, high interrater reliabilities were achieved by this procedure. The coding of the entire sample of n = 198 patient reports yielded the following results. Of all problems, depressive complaints, bodily complaints, anxiety and interpersonal problems were most frequent. The most important goals concerned coping with anxiety, gaining joy of living/happiness/satisfaction, greater self-assertion, better family relations/partnership, coping with problems and peace of mind/calmness. The categories of goals (18 items) seemed to be more complex and manifold than the categories of problems (10 items) and went beyond mere reduction of complaints or problems. As was to be expected, differences between diagnostic groups with regard to frequency of problems and expectations could be demonstrated. However, these differences were found only in the frequencies of deficits (complaints and problems) and reduction of complaints or coping with problems, respectively, whereas positive, health-related goals did not seem to be specific to the disorder. This suggests that it would be worth while to utilise patients' subjective definitions of problems and goals for assessment schedules to evaluate treatment outcomes.

Adolescent↗
PubMed1998

[Psychotherapy research--how it should (not) be done. An expert reanalysis of comparative studies by Grawe et al. (1994)].

22 psychotherapy outcome studies used in the Bernese meta-analysis by Grawe, Donati and Bernauer (1994) for a treatment comparison between behavioural and psychoanalytic-psychodynamic treatment concepts were reanalysed by 12 expert psychotherapy researchers independent of each other. Three clinical criteria served as basic criteria for the assessment of the methodological quality of the 22 comparative studies: treatment dosage, therapists' competence or expertise, and an adequate realisation of the intended treatment concept. The expert ratings were then compared with an evaluation of an assessment of a research team from the University of Ulm and with the one from the Bernese research team. Contrary to the Bernese meta-analysis, both the experts and the Ulm research group conclude that only 5 or 8 of the 22 studies, respectively, could be accepted for a relatively fair comparison between the treatments under study. Out of the 5/8 studies, none could be considered fully suitable for a treatment comparison, at the most only moderately suitable. These remaining 5 or 8 studies, respectively, do not prove superiority of one treatment over the other. Hence, the "Dodo Bird Verdict" stands up under scrutiny.

Behavior Therapy↗
PubMed1997

[The clientel of a psychotherapeutic polyclinic in the light of a documentation base].

A documentation system for use during the diagnostical process with psychotherapy outpatients is outlined, and sociodemographic, medical and psychosocial data of newly admitted patients of a university psychotherapy outpatient department are presented. The population structure is described on the basis of data collected during the first 18 months of the implementation of the assessment system. Data are compared with those of other psychotherapeutical institutions that differ with regard to setting (outpatient vs. inpatient), health care sector (acute care vs rehabilitation) and geographic region. Sociodemographic and medical data are given. Patients' mean age is 33.5 years. Two-thirds of the patients are female. The majority is single and has higher formal education. Slightly more than half of the patients are working. Modes of admittance, somatic and psychological complaints and aspects of illness behaviour are described. Pertaining to diagnostical classification, affective disorders (34%), somatoform disorders (15%) and anxiety disorders (11%) are most frequent. Mean duration of symptoms is 6 years. However, only few patients had prior psychological treatment. Treatments most frequently selected at the time of assessment were psychodynamic psychotherapy (41%), behavioural therapy (24%), and group therapy (10%). When comparing the study population with those of other institutions, differences showed up especially in contrast to rehabilitation clinics, where older, male, and working persons as well as those with somatoform disorders and longer durations of illness are more frequent.

Adult↗
PubMed1997

[Do psychological factors modify survival of cancer patients? I: Review of the literature].

The present paper addresses the question whether psychological factors influence the course of the disease in cancer patients. Studies investigating this issue are reviewed from a methodological point of view. The main objective is to design guidelines for future research. The review begins with Greer's and his co-workers' study on breast cancer patients. They demonstrated that ways of coping called fighting spirit and denial are predictive of longer survival. However, axillary lymph node status and oestrogen receptor status could not be controlled, because these measures had not been assessed on a routine basis at the time of diagnosis. The Greer study has been stimulating a series of replications. Moreover, investigations into patients with various other cancer sites including melanoma and lung cancer have been performed. In general, results were inconsistent. Studies with positive findings are contrasted by those with negative results. Within positive findings, results were partially contradictory. Moreover, most of the investigations suffered from serious methodological limitations rendering interpretation difficult. The following methodological conclusions can be drawn: Testing of a priori hypotheses instead of multiple retrospective tests; prospective design to prevent that psychological predictors turn out to be indicators of the somatic state of the patient; multi-method and longitudinal assessment of coping and adaptation; homogeneous sample; taking into account all known biological prognostic factors; multivariate statistical analysis.

Adaptation, Psychological↗
PubMed1997

[Do psychological factors modify survival of cancer patients? II: Results of an empirical study with bronchial carcinoma patients].

The present prospective test study of hypotheses addressed the question whether psychological factors are predictive of survival time in lung cancer patients. The hypotheses were: Emotional distress, depression and depressive coping are associated with shorter survival; hope and active coping with longer survival. The study was based on a sample of n = 103 patients who were investigated post-diagnosis and before the beginning of primary treatment. Emotional distress and hope were assessed by clinical scales (self-reports and interviewer ratings), depression by the Depression Scale of von Zerssen, depressive coping and active coping by the Freiburg Questionnaire on Coping with illness by Muthny. At follow-up, which took place three to five years later, n = 74 patients had died, for n = 29 patients the survival data are censored. The prediction of the survival time was performed applying multivariate analyses (Kaplan-Meier-method, Cox-Regression), adjusting for biological risk factors (histological classification, stage of the disease, type and amount of treatment, Karnofsky performance status, age). Results were as follows: Active coping and hope were associated with longer survival, emotional distress, depression and depressive coping with shorter survival, respectively. These associations were found consistently across assessment methods. The predictive effects of coping and distress were statistically independent of the influence of the somatic risk factors. The best psychological predictor was the interviewer rating of active coping. Its predictive power equalled that of the Karnofsky performance status. However, there was evidence that the effects of the psychological factors varied somewhat in interaction with treatment modalities. The findings are discussed from a methodological perspective. Possible causal models and mechanisms are presented which could account for interactions of psychological measures and the course of the disease: Thus, it can be conceived that psychological effects were mediated by patients' compliance with medical treatment. In addition, it cannot be ruled out that psychological factors themselves were influenced by the physical status of the patients at the time of entry to the study.

Adaptation, Psychological↗