[Patients with physical pain but no organic correlate].
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Adaptation, Psychological↗
Biomedical subjects
H Gündel
Publications and source records attributed to H Gündel.
[Neurofeedback-based EEG alpha and EEG beta training. Effectiveness in patients with chronically decompensated tinnitus].
BACKGROUND: Persisting tinnitus is an often devastating disease condition with restricted and rarely successful therapeutic options. PATIENTS AND METHODS: The present study investigates the therapeutic effect of short term neurofeedback-based EEG-Alpha- and EEG-Beta-training in 40 patients suffering from "chronic decompensated tinnitus". Patients were assigned to the Alpha or Beta group according to results of an initial EEG monitored stress-test. Four patients were excluded because they showed abnormal reactions in both EEG patterns. RESULTS: During 12 sessions, 23 patients succeeded to increase EEG Alpha activity by 16% (p< or =0.042) while 13 patients achieved no decrease of EEG Beta activity. However, both groups showed a significant reduction of subjective tinnitus annoyance by the end of the therapy (p< or =0.001) CONCLUSIONS: The results indicate that neurofeedback may represent a new promising technique in the therapy of chronic decompensated tinnitus. However, it remains to be established whether the reduction of tinnitus annoyance results from the altered brain activity patterns supported by the neurofeedback learning process.
Adult↗
[Irritable bowel syndrome: the challenge to psychosomatic and internal medical specialists to collaborate closely].
The irritable bowel syndrome is a ubiquitous disease that usually exhibits a close affinity to the group of somatoform disorders. Chronic cases in particular often suffer from psychological disturbances, and consult numerous different medical, mainly internistic-gastroenterological, treatment centers, not infrequently with no lasting success. Although the importance of gastroenterological pathophysiological aspects is beyond doubt, an early interdisciplinary diagnostic work-up--with explicit involvement of the psychosomatic-psychotherapeutic specialty--is urgently recommended. Against the background of moderate concomitant medication, a psychosomatic-psychotherapeutic treatment regimen has proven successful.
Antidepressive Agents↗
Alexithymia is no risk factor for exacerbation in spasmodic torticollis patients.
OBJECTIVE: To assess whether alexithymia is a risk factor for exacerbation in spasmodic torticollis (ST). METHODS: ST patients (2 x 10) with high vs. low alexithymia scores (mean score on the 20-item Toronto Alexithymia Scale [TAS-20]=69.2 vs. 28.7) were compared on physiological, motor and subjective responses to a cognitive and an emotional laboratory stressor. Changes in sustained abnormal head/shoulder positions and maximum range of motion (ROM) of the cervical spine were kinematically quantified. Skin conductance level (SCL), nonspecific skin conductance fluctuations (NS.SCF), heart rate (HR) and skin temperature (T) were measured. RESULTS: High alexithymia had no effect on the abnormal head posture or movements, but high-alexithymic ST patients showed generally increased levels of autonomic arousal (more NS.SCF, higher SCL; analysis of variance [ANOVA]: P=.016 and P=.051, respectively) under all experimental conditions. When ST symptom severity (TSUI-score) was partialled out, these group differences were somewhat reduced (analysis of covariance [ANCOVA]: P=.052 and P=.143). CONCLUSIONS: High alexithymia did not lead to increased abnormal head movements to stressors, but may result in a subtle increase in tonic level of sympathetic activity.
Adult↗
[Criteral for assessing quantitative disability in expert determination of functional physical disorders. Review of the literature].
The assessment of individuals with somatoform disorders seeking payments or compensation is a major challenge for psychiatrists, insurers and the social welfare system. It is difficult to examine these disorders objectively and to quantify the impairment people experience in their work or private life. In order to develop more rational criteria for the assessment of these patients, we first reviewed the relevant literature and extracted the criteria mentioned by the respective authors. We then grouped these criteria in clinically plausible dimensions in order to develop a list of parameters that could help psychiatric experts to analyse the impairment more objectively and to help institutions in evaluating the assessments.
Activities of Daily Living↗
[Differential and common characteristics of patients with atypical facial pain and craniomandibular dysfunction].
BACKGROUND: Craniomandibular disorders (CMD) and atypical facial pain (AFP) represent a clinical challenge. Whereas CMD patients respond to somatic approaches, somatization should be strictly avoided in AFP. The aim of this study was to establish prognostic criteria to identify an aggravated risk of a chronic course in CMD and AFP. METHOD: A total of 124 consecutive patients with CMD ( n=108) or AFP ( n=16) were examined by two interdisciplinary academic pain centers. Psychometric evaluation was conducted with standardized questionnaires (SCL-90R, STAXI, modified SBAS-IV). All patients were clinically assessed by a maxillofacial surgeon or specialized dentist. RESULTS: The following variables proved to be significant: age (risk for AFP vs CMD increased by 6% p.a.), decreased dysfunction index (13% higher risk for AFP vs CMD), and low scores concerning outwardly directed anger (12% higher risk for AFP vs CMD). There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor ( p<0.001) for patients presenting high initial pain with a marked discrepancy between somatic findings and subjective status. CONCLUSIONS: CMD patients differ from AFP patients regarding age, psychosocial isolation, outwardly directed anger, and a decreased dysfunction index. Additionally, initial pain intensity in patients presenting indistinct CMD/AFP can be considered as a valid predictor for a chronic course in pain.
Adolescent↗
[Psychic and somatic findings in jaw or facial pain of unclear origin. Comparison of patients with severe and mild symptoms].
BACKGROUND: Both for medical and dental specialists, patients with facial arthromyalgia (FAM) and acute or chronic atypical facial pain (AFP) often represent a clinical challenge. Only few empirical studies address the possible interaction between facial pain and increased psychosocial stress with a thereby heightened risk for a chronic course of disease. OBJECTIVE: To evaluate whether FAM or AFP - patients initially presenting with high vs. low pain intensity differ in somatic, psychosocial and socioeconomic parameters. METHOD: We chose to study a population with a primary diagnosis of myofascial pain of the jaw muscles or atypical facial pain and excluded patients with disc displacement, acute arthritis and severe arthrosis. Within nine months, 124 consecutive patients with FAM ( n=108) or AFP ( n=16) were referred to the departments of maxillary surgery, dentistry or neurology of two interdisciplinary academic pain centers. Using the patients'ratings on a 100 mm visual analogue scale concerning their pain intensity, the group was divided in a subgroup initially presenting with low (VAS</=5; n=50) and high pain (VAS>5; n=45). Psychometric evaluation was conducted with the SCL-90R (general psychopathology), the State-Trait-Anger-Expression Inventory (STAXI) and a special questionnaire addressing different aspects of chronic pain (modified SBAS-IV). All patients were assessed by a maxillary surgeon/specialized dentist with the help of a detailed, standardized clinical examination (Helkimo-Index). RESULTS: The group of FAM-/AFP - patients according to our inclusion-/exclusion - criteria presenting with a high pain intensity showed more psychosocial withdrawal ( p=0.013), a worse self-rated psychological status ( p=0.033) and a trend towards more somatization ( p=0.093) than patients with lower pain intensity. There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor (p<0.001) for belonging to the high (extensive) pain group. CONCLUSIONS: These data suggest that FAM-/ AFP - patients initially presenting with a high pain intensity have an increased risk for psychosocial stress and maladaptive coping behaviour. As both variables are empirically validated risk factors for a chronic course in pain-related disease, these patients should be of special interest for an interdisciplianary therapeutic setting including psychotherapeutic approaches.
Acute Disease↗
Social phobia in spasmodic torticollis.
OBJECTIVES: To study the prevalence of psychiatric comorbidity assessed by the use of a structured clinical interview in a large, representative sample of patients with spasmodic torticollis (ST) and to test the hypothesis that social phobia would be highly prevalent. METHODS: In a consecutive cohort of 116 patients with ST treated with botulinum toxin overall psychiatric comorbidity was studied prospectively with the structured clinical interview (SCID) for DSM-IV axis I disorders. Physical disability and psychosocial variables were also assessed with standardised self rating questionnaires. RESULTS: 41.3% of the subjects met DSM-IV clinical criteria A-G for current social phobia as the primary psychiatric diagnosis. This figure rose to 56% including secondary and tertiary psychiatric diagnosis. There was no correlation between severity of disease (Tsui score, severity of pain, body image dissatisfaction score) and psychiatric comorbidity. The only significant predictor of psychiatric comorbidity was depressive coping behaviour (logistic regression analysis, p < 0.01; OR=10.8). Compared with a representative sample of the general adult population, in the patients with ST the prevalence of clinically relevant social phobia is 10-fold, of mood disorders 2.4-fold, and of lifetime psychiatric comorbidity 2.6-fold increased. CONCLUSIONS: A particularly high prevalence of social phobia was found in the cohort of patients with ST. The finding of a high prevalence of social phobia and depressive coping behaviour as the main predictor of psychiatric comorbidity may make a subgroup of patients with ST particularly amenable to specific psychotherapeutic interventions.
Adaptation, Psychological↗
[Current perspectives of alexithymia].
Although alexithymia is found in patients with various somatic disorders, it remains unclear whether it is really related to organic disease--as proposed by the founders of the concept.[125]. As the interplay between the experience of emotion and possible adverse effects on health is a fundamental tenet of psychosomatic medicine, alexithymia remains an interesting concept to be further explored, especially concerning (1) possible pathways linking emotion to physical illness and (2) the neurobiologic basis of emotional information processing. Compared to the intense international discussion on the subject, in Germany there are still many doubts concerning alexithymia: while some clinicians question the validity of the whole concept, psychiatric and psychosomatic researchers seem unsure about alexithymia's role in their search for a physiological basis to the link between emotion and physical disease. Our review deals with the empirical literature concerning that possible association and tries to tie in their data with modern, neuro-biologically founded insights into emotional information processing within the brain.
Affective Symptoms↗
[Consultation and liaison activity from the socioeconomic perspective. A plea for cost-benefit analysis in psychosomatics].
Within the last decade cost-effectiveness assumes a much more strategic perspective in the rationing of care that is taking place due to evidently increasingly limited financial resources and managed-care driven protocols. As universities and general hospitals face this increasing pressure to justify services within their facilities, consultation-liaison (C/L) programs need to carefully address and evaluate the financial base of the services they provide. Overlooking or neglecting the financial aspects of C/L-services has already resulted in the closure or service reduction of C/L-programs throughout the United States. Whereas a result of that development interest in cost-effectiveness research is considerable in the US and GB and has produced some good evidence for the impact of psychosocial problems on the outcome and cost of medical care, nearly no such studies come from the German-speaking countries. The present article reviews the worldwide existing literature concerning cost-effectiveness analyses of C/L-work and attempts to guide the reader through the currently available methods for cost-effectiveness research. As a conclusion we propose somatisation syndromes as one patient group. There the development of appropriate treatment regiments is vital both concerning clinical and socioeconomical aspects.
Cost-Benefit Analysis↗
[Current neurological findings support psychosomatic assumptions].
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Humans↗
[Psychiatric-psychotherapeutic teaching interview as experienced by the patient and interview-conducting students. An empirical study].
After the exploration of the psychiatric patient by a medical student in the context of a small psychiatric teaching-group (Psychiatric Clinic, University of Münster) was finished, both medical students and patients (n = 94 each) were asked about their experiences during that interview by means of a special questionnaire: Most patients reported about positive effects of the educational interview. 60% of the patients spoke about a positive prove of regained strength, 35% gained new or deeper insights. On the other hand 10% of the patients made worrying and unpleasant experiences. Students diminished their anxiety to hurt patients by asking too intimate questions. 30 to 40% of the students reported about difficulties in structuring a clinical interview, especially with patients who refused to talk or didn't answer the students' questions correctly. 60% of the students made also emotional learning experiences.
Adaptation, Psychological↗
Schizophrenic autism. 1. Historical evolution and perspectives.
Cardinal importance has often been attached to the term 'autism' within the scope of schizophrenic symptomatology since its introduction by E. Bleuler in 1911. However, this term has been used purely intuitively in most cases, giving rise to a great deal of speculation about autism and its role within different psychiatric disorders, speculation which could not then be examined empirically for lack of intersubjective definition. This article reviews and examines the historical concept of autism, and finally makes and discusses proposals for future perspectives on autism.
Autistic Disorder↗
Schizophrenic autism. 2. Proposal for a nomothetic definition.
Since its introduction by E. Bleuler in 1911, the so-called 'basic symptom' autism has often been considered cardinally important within schizophrenic symptomatology. A lack of precise definition and hence of reliability, however, has eroded the former importance of this term, which cannot be found in modern diagnostic systems. Using a specific text-analytical method, we evaluated all accessible publications on schizophrenic autism, focusing on the descriptive-empirical approach. The entire material was then summed up in five essential points, providing a possibly more reliable (nomothetic) explication of the complex term of autism.
Affective Symptoms↗
[A case report on a 9-day-long abuse of propofol].
This case report deals with the case of an alcohol-dependent, but abstinent patient, who took 3 x 5 ml/d (= 150 mg) propofol intravenously for nine days. Anxiety, inner tension and restlessness routine which had previously occurred during his daily vanished. No other psychotropic effects occurred.
Adult↗
Identifying somatization disorder in a population-based health examination survey: psychosocial burden and gender differences.
Despite its enormous medical burden, little is known about the epidemiology of somatization in the community. The present study screened a representative population-based survey of 7,466 subjects in the age range of 25 to 69 years for the occurrence of somatization. A total of 137 (1.84%) individuals experienced six or more symptoms from at least two different body sites without an identifiable organic cause. These patients exhibited a lower quality of life (P < or = 0.0001) and suffered from higher levels of emotional stress (P < or = 0.0001) than their counterparts in the healthy subsample (n=906). Somatization was not associated with a medical diagnosis, but disability days, the use of medical services, and the level of medication was higher in the somatization disorder group (P < or = 0.004). The somatization risk was only 1.6-fold higher for women in comparison to men but escalated for women rapidly to an approximately 4-fold risk when being female was combined with low social class and high emotional distress. Against expectation, the somatization risk for men also mounted 3-fold under the identical risk constellation.
Adult↗