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Biomedical subjects

H Faller

Publications and source records attributed to H Faller.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1996

[Causal "cancer personality" attribution--an expression of maladaptive coping with illness?].

In psycho-oncology, the concept of a "cancer-prone personality" has gained some attention. This notion means that persons who try to stay pseudo-normal in spite of severe life stress, suppress negative emotions, particularly anger, and sacrifice themselves for other people without uttering any personal demands, are at a high risk to develop cancer. However, it has been demonstrated by previous research that features of the cancer-prone personality could only be found if the ill person was convinced to suffer from cancer, irrespective of what the factual diagnosis was. Thus it can be concluded that at least some aspects of the so called cancer personality might be the results of coping with the belief of having cancer. The present study had the objective to describe causal attributions to psychosocial factors in cancer patients, and to find out if these were connected with emotional state and coping. N = 120 newly diagnosed lung cancer patients were included in the study. The instruments consisted of a semi-structured interview, a check-list of subjective causal factors, self-reports and interviewer ratings on emotional state and standardised questionnaires about depression and coping. Patients who made a psychosocial causal attribution proved to suffer from greater emotional distress, to be more depressed and less hopeful than other patients. This difference seemed to be mediated by a depressive way of coping with the illness (brooding, wrangling). Thus, an attribution of the illness to psychological factors seems indicative of a maladaptive way of coping with illness. This result is supported by similar findings of previous research. The question is put up to discussion if the psychosomatic concept of a cancer personality may reflect patients' subjective theories which in turn may be the expression of their depressive coping modes.

Adaptation, Psychological↗
PubMed1995

Causal attribution and adaptation among lung cancer patients.

The aim of the present study was to describe lung cancer patients' causal attributions and examine their associations with adaptation. Methods were based on semi-structured interview, content analysis, self-reports, interviewer ratings and standardized questionnaires. 'Smoking cigarettes' and 'toxins in the work place' were the most commonly mentioned possible causes. Patients who made a psychosocial causal attribution suffered greater emotional distress, were more depressed, and less hopeful than other patients. They were also more likely to be rated as showing a maladaptive way of coping with illness. The implications of these findings for psychosocial care are discussed.

Adaptation, Psychological↗
PubMed1995

[Social support and social stress in tumor patients and their partners].

Social support is widely believed to be an important buffer against stress in patients coping with cancer. Support efforts can, however, in turn prove to become a source of distress in themselves, both in patients and support providers. The present study was designed to explore the connections between support and emotional distress. N = 120 lung cancer patients and their relatives (n = 57) are interviewed at three intervals. Social support is assessed by multiple methods: Content analysis, a questionnaire and a confidant rating performed by experts. Cross-sectional and longitudinal analyses are combined. Content-analytical and self-report data show a correlation of support efforts and emotional distress. In the confidant rating, however, the expected differences between supportive and non-supportive spousal relationships emerge. The results are discussed from an interactional point of view.

Adaptation, Psychological↗
PubMed1995

[Psychosocial causal attributions by myasthenia gravis patients. A longitudinal study of the significance of subjective illness theories after diagnosis and in follow-up].

The present study evaluates the impact of subjective theories of illness in patients suffering from Myasthenia gravis. 46 inpatients were examined after the diagnosis had been made (T1) and 6 months later (T2). The following instruments have been used: a semistructured interview, the ¿Freiburg Personality Inventory¿ (FPI), the ¿Freiburg Questionnaire of Coping with Illness (FKV) and a questionnaire for the judgement of body experiences (FBK). Ratings concerning neurotic symptoms (PSKB), mechanisms of defence (KBAM) and the doctor-patient-relationship were made by the interviewers and the treating neurologist as well. 35% of the patients experienced a connection between psychosocial factors (stress) and the onset of the disease. As compared with those patients not showing a psychosocial causal attribution there are no differences in somatic (type and severity of the disease, thymus histology), but in psychological variables. Patients attributing their disease to psychosocial factors prove to be more depressive, insecure and excitable at T1. They are more likely to be women. These findings are in accordance with the results of previous studies. However, 6 months later (T2) there is some evidence of a psychological stabilization of those patients using psychosocial attributions, as different instruments show concurrently. Partially they appear now even less depressive. This result is understood as a hint for the significance of emotional factors for the process of coping with the disease: patients using a psychosocial explanation concept may appear more vulnerable at an early stage of the disease. But perhaps, by this more emotionally centered coping process, they can reach stability which is connected with the construction of a psychosocial theory of the disease.

Adaptation, Psychological↗
PubMed1994

[Subjective illness theory and coping with illness by brain tumor patients].

The present study was designed to describe theories of illness and coping with the disease in brain tumor patients. It addresses the following questions: 1. To what attribute brain tumor patients their illness? 2. How do they cope? 3. Are causal attributions and coping modes related to emotional states, such as distress, hope, and depression? N = 33 newly diagnosed patients suffering from benign or malignant intracranial tumors are included in the sample and interviewed presurgically. Assessment methods combine both qualitative and quantitative instruments. Among the causes discussed in the interviews are incidents that can be classified as mechanical traumata. They have the highest frequency. In patients' self-reports, distress is rated low, hope high. Interviewers rate distress higher and hope lower. Among the modes of coping, compliance, fighting spirit (as assessed in a questionnaire), distraction, social support, optimism, and acceptance of the disease (as assessed by interview and content analysis) are the most frequent. The results are discussed under methodological and illness-related perspectives.

Adaptation, Psychological↗
PubMed1993

[Subjective illness theories: determinants or epiphenomena of coping with illness? A comparison of methods in patients with bronchial cancer].

The present paper analyzes subjective causal models in lung cancer patients. It addresses two questions: 1. What method is apt to assess subjective theories of illness? 2. What relationships can be found between subjective theories of illness on the one hand and emotional status and coping on the other hand. Subjective causes of the disease, assessed by a semi-structured interview and by a questionnaire respectively, are compared. Some connections with emotional status are tested. Univariate analyses show that certain causal models ("air pollution", "psychological cause") co-vary with emotional distress. This relationship, however, seems to be a result of a specific way of coping that works as a intervening variable, with which both subjective theory and emotional distress are confounded. The univariate connection can no longer be maintained when this way of coping is included in multivariate analysis. The question is discussed, whether subjective causal concepts may be determinants or epiphenomena of coping.

Adaptation, Psychological↗
PubMed1992

Coping and adaptation in pancreatectomized patients: a somatopsychic perspective.

The present study describes various strategies of coping with illness as observed in pancreatectomy patients, a group of patients which has not been investigated before in this field of research. Questionnaire data obtained from a sample of n = 134 were analyzed with regard to sociodemographic (age, sex) and medical characteristics (indication for surgery: chronic pancreatitis vs. pancreatic carcinoma; outcome after surgery: diabetes, hypoglycemia, pain). The relationships between ways of coping and several adaptation criteria were investigated. The question is put up to discussion, if it is possible to clearly separate emotion as a way of coping and emotion as an outcome of coping.

Adaptation, Psychological↗
PubMed1990

Coping with myocardial infarction: a cognitive-emotional perspective.

The present paper attempts to make a cognitive-emotional reconstruction of the old, as yet unresolved question as to what role anxiety and denial play as response to acute myocardial infarction (MI). Anxiety is understood as the turning of attention to features of threat, and denial as turning attention away from these features. Each direction is supported by mental argumentations, which is to say subjective theories. A number of relationships between emotional coping and somatic symptoms, such as angina pectoris or atypical chest pain, are treated at greater length. The main areas of perceived stress, lay concepts of etiology, and expectations regarding rehabilitation are explored, taking a cognitive-emotional perspective. The results are discussed in the light of the crucial issue of acceptance MI patients have of psychological treatment.

Activities of Daily Living↗
PubMed1989

[Emotional processing of perceived stresses by myocardial infarct rehabilitation patients: a speech content analytic study of affect in narrative interviews].

The present study investigates emotional coping with stress due to myocardial infarction (m.i.). It aimed at answering three questions: 1) In what respect do m.i. rehabilitation inpatients perceive stress? 2) What are the emotional implications of perceived stress? 3) Are m.i. patients alexithymic? Content analysis of verbal data obtained by a semi-structured interview, which includes a narrative part suitable to Gottschalk Gleser Content Analysis of anxiety and hostility, reveals that m.i. rehabilitation patients perceive adaptative tasks in the areas of bodily damage, psychic restrictions, loss of self esteem, and challenge to social identity, in their experience at the time of the interview as well as retrospectively in the acute phase. Emotional coping employed in these fields can be interpreted 1) as defence of needs for dependence and regain of autonomy and 2) as narcissistic rage as a response to narcissistic mortification. The speech of m.i. patients resembles that of psychosomatic patients. Finally, factors that influence the expression of emotions in a research interview are discussed.

Adaptation, Psychological↗
PubMed1989

[Coping with disease from the psychosomatic-psychotherapeutic viewpoint exemplified by pancreatectomized patients].

In the past few years psychosomatic medicine, apart from investigating the psychosocial sources of bodily disorders, has begun to focus also on the opposite side of the problem, the question of how people experience illness and cope with it. This "somatopsychic" view can be regarded as a supplement to the so far prevailing psychosomatic perspective and its approach. The present study describes and analyzes various strategies of coping with illness as observed in a group of pancreatectomized patients, a group of patients which has not been investigated before in this field of research. Based upon the experience of long-term psychotherapeutic care, the study differentiates between the more problematic and the more beneficial forms of coping, and empirically verifies their prevalence and adaptivity in a sample of pancreatectomized patients, not selected with regard to the extent of care needed. The findings are discussed from the methodological and the psychosomatic-psychotherapeutic point of view.

Adaptation, Psychological↗
PubMed1989

[A case report on the phenomenology and psychodynamics of pain in acute myocardial infarct].

The experience of pain during an acute heart attack is analysed from a phenomenological perspective. It can be shown that the intensity of the pain challenges the myocardial infarction patient's ideal of autonomy and confronts him with dependencies-the dependency on one's body, the dependency on other people-that make him feel ashamed. Thus, emotions of anxiety and shame are often present during the process of coping with pain. The interactional relationships of the patient seem to play an important role in the development of these feelings.

Adaptation, Psychological↗
PubMedDate not supplied

[I. Cultural adaptation, practicability and reliability evaluation of the Musculoskeletal Functional Assessment Questionnaire].

INTRODUCTION: The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to translate and culturally adapt the short musculoskeletal function assessment questionnaire (SMFA) into German and to evaluate the practicability, metric properties, and distribution characteristics of the German version (SMFA-D). METHODS: The SMFA is a questionnaire on the functional status of the musculoskeletal system of patients consisting of a function index (34 items) and bother index (12 items) with a 5-point response format. The SMFA was independently translated by orthopaedic-trained, qualified German- and English-speaking translators. A consensus committee review and selection of an optimally comprehensible German version was performed. Patients checked this version for comprehensibility and time to complete the questionnaire. 40 fluently German-speaking patients with primary osteoarthritis of the knee completed the SMFA-D twice at a one week interval. The test-retest reliability and internal consistency were evaluated. The values are standardized on an scale from 0-100. High values indicate a poor function. RESULTS: The SMFA-D is comprehensible and can be completed within 20 minutes in the mean. There were no skewness and no floor or ceiling effects. The mean function index was 47 (SD 17, range 16-80). The mean bother index was 44 (SD 19, range 5-75). Test-retest reliability were 0.88 (function index) and 0.71 (bother index), respectively. Internal consistency (Cronbach's alpha) was 0.92 (function index) and 0.88 (bother index), respectively. CONCLUSIONS: The SMFA-D is a practical and reliable questionnaire for patient-based evaluation of functional problems of the musculoskeletal system.

Aged↗
PubMedDate not supplied

[II. Validity and sensitivity to change of the Musculoskeletal Functional Assessment Questionnaire in primary gonarthrosis and total endoprosthetic joint replacement].

INTRODUCTION: Scoring systems used so far in total knee arthroplasty are limited by their non-fulfillment of basic test criteria. The aim of the study was to demonstrate the validity and responsiveness of a German version of the new short musculoskeletal function assessment questionnaire (SMFA-D) in patients with primary osteoarthritis and total knee arthroplasty. METHODS: 66 patients with a tricompartmental cemented PFC-Sigma total knee arthroplasty completed the SMFA-D and the WOMAC questionnaire preoperatively and at 12 to 16 weeks follow-up. Preoperatively, physicians' rating of function of the leg, patients' self-selected walking speed, pain and arthritis severity score were registered for demonstration of criterion validity. Construct validity was evaluated with the WOMAC. Discriminant validity was assessed by comparing patients with or without previous surgery at the knee, use of pain medication and use of walking aids. The function and bother indexes of the SMFA-D were correlated with these parameters. Standardized response means were calculated. RESULTS: The function index correlated with physicians' rating (r = 0.51), walking speed (r = 0.61), pain (r = 0.36) and the arthritis severity index (r = 0.36). The bother index correlated with pain (r = 0.37) and the arthritis severity index (r = 0.25). The function and bother index correlated with the WOMAC (r = 0.77) and (r = 0.81), respectively. Patient groups with or without walking aids (p = 0.02) and with or without pain medication (p = 0.001) differed in the function index. The bother index of patients with or without pain medication (p < 0.001) and with or without walking aids (p < 0.006) differed. Function and bother index improved from 46 (SD 17) to 34 (SD 19, p < 0.001) and 43 (SD 18) to 33 (SD 22 p < 0.001), respectively. The standardized response mean was 0.86 for the function index and 0.53 for the bother index. CONCLUSIONS: The SMFA-D questionnaire is valid and responsive in patients with primary osteoarthritis of the knee and total knee arthroplasty. It measures function and bother from the perspective of these patients.

Aged↗
PubMedDate not supplied

Emotional state, coping styles, and somatic variables in patients with chronic hepatitis C.

The authors in a cross-sectional study examined 113 patients with chronic hepatitis C (CHC) without widely progressed or decompensated liver disease. The patients were investigated for emotional state (depression, anxiety, coping styles) and somatic/sociodemographic variables. A high percentage of patients had positive scores for depression (22.4%) and anxiety (15.2%). Mode of acquisition (e.g., former drug abuse) and histological grade of liver damage had no significant influence on emotional state or coping strategies. Older patients (> or = 50 years) were significantly more depressed (P = 0.024). Patients with a recently diagnosed CHC (> 4 weeks, < 6 months) had significantly lower scores for depression (P = 0.003) and anxiety (P = 0.001) than the subgroup with a time interval since initial diagnosis of more than 5 years. Recently diagnosed CHC patients also showed the highest levels of problem-solving behavior. Patients who were advised not to undergo an interferon therapy were significantly more depressed (P = 0.001) and anxious (P = 0.028). Older patients with CHC and patients with a long period since CHC diagnosis or who were advised not to undergo interferon therapy should be carefully and regularly assessed for depression, anxiety, and inappropriate coping styles.

Adaptation, Psychological↗