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Biomedical subjects

H Schepank

Publications and source records attributed to H Schepank.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Is there a typical conflict in dyspepsia? An epidemiologic psychoanalytic contribution to the topic of a specific conflict in psychosomatic medicine].

The question whether a dependency-independency-conflict is specific for subjects with gastric complaints was investigated by means of a representative, psychoanalytic-epidemiologic field study (Mannheimer Kohortenprojekt). Out of a population of 600 adults probands with dyspepsia were compared with individuals with musculoskeletal symptoms and "healthy" subjects. Using interview protocols of these individuals two "blinded" raters judged whether the conflict under consideration was present in different aspects of life. It could be confirmed that subjects with gastric complaints showed the conflict significantly more often than either control group. However, the conflict was also found among individuals of either control group. It can be concluded that the dependency-independency-conflict is typical, but not specific for subjects suffering from dyspepsia.

Adult↗
PubMed1993

[Why "no" to psychotherapy? Cognitive stereotypes of psychosomatic patients of a population sample in correlation with refusal of offered psychotherapy].

Practical and organizational reasons, e.g. problems of timing, and strain factors in private or professional life are cited predominantly when probands spontaneously utter their motives for the non-acceptance of an offer of psychotherapy. In the second place, a lack of insight into the necessity of this kind of treatment is indicated as motive for the rejection of a therapy offer. An exploration of the probands leads to a change in the frequently distribution of the motives uttered to refuse psychotherapeutic treatment. Basically, the differentiation of the answers increases (indication of more than one category of motives). A negative attitude to or fear of psychotherapy was indicated considerably more often, especially by women. Those--mostly male--probands, who had pointed out that a lack of insight into the necessity of psychotherapeutic treatment was the decisive factor for their non-acceptance of the therapy offer, adhered most consistently to their argumentation also after exploration. The statistical analysis of possible determinants for the different styles in which probands state the motives for their rejection revealed significant sex differences. These findings suggest that the uptake of psychotherapeutic treatment is also guided by sex role sterotypes.

Adult↗
PubMed1993

[Psychometric assessment of defense mechanisms: correlation between questionnaire and expert rating. Initial study of validity].

Within the limits of an epidemiological longitudinal field survey on prevalence and course of psychogenic disorders a high-risk-population suffering from medical psychogenic impairment was investigated. The study was conducted in order to verify an etiological multi-level-model of psychogenic disorders in relation to the socialempiric variables "critical life events" and "social support" as well as the depth psychological oriented construct "personality". Besides other instruments a self rating scale based on Vallant's hierarchical model of defense, i.e. the german adaptation of the DSQ (Defense Style Questionnaire) of Bond and coworkers, was used for the accurate measurement of relevant personality parameters. Although defense processes predominantly work unconscious, manifestations of defense mechanisms could be measured indirectly by means of the rating scale. Its essential dimensions separated clinical patients from a group of healthy controls. Furthermore an immature organisation of defense was found to be related to psychogenic impairment. Concerning self- and expert-rating a significant correlation between "immature defense" and the defense mechanisms "schizoid phantasy", "projection" and "acting out" was proved.

Adult↗
PubMed1993

[KOPS: a self-rating instrument for assessment of physical, psychological and social communication impairments].

In this article the development of a self-rating symptom questionnaire is described. The questionnaire records physical, psychological and social-interactionary impairments typical for neurotic and psychosomatic disorders. Contrary to most of the established self-assessment instruments the KOPS-questionnaire consequently records symptoms from these three areas. The questionnaire contains 64 items scaled on four steps and can be filled out by the test person in a short period of time. The results depicted here from different sample groups which were examined verify the differential and criterion related validity and furthermore an explorative factor analysis also verifies the content validity. The instrument is suited for screening purposes as well as for clinical course studies of psychological disorders. The problems of the assessor perspective (by an expert or by a patient) in recording symptoms is discussed.

Adult↗
PubMed1992

[Participation refusal by probands in an epidemiologic long-term study--sociodemographic, clinical and psychometric findings].

Usually little is known about probands who participated in an epidemiological longitudinal field survey but refused participation in follow-up investigations. For reasons of data protection and on account of the fact that investigative instruments used in longterm field surveys or panel studies are more focused on well defined issues (opinions, attitudes, assessment of behaviors) and less on personality variables, differentiated statements on probands who explicitly refused cooperation can hardly be made. In our epidemiological longitudinal field study on prevalence and course of psychogenic disorders we have a different situation. Within the limits of our study we had the unique opportunity to gain far-reaching information on probands who refused to participate in preceding investigations in regard to sociodemographic, psychometric and clinical variables. The clientele of refusers we present in our paper mainly comprises elderly, married, rather obsessive-compulsive structured, lower-class females. According to our data interactive aspects are equally responsible for reduced cooperativeness. The significance of our findings for the planning and carrying out of epidemiological longitudinal field surveys is discussed.

Adult↗
PubMed1991

Patterns of self-definition of asthma patients and normal persons in the Freiburg Personality Inventory.

The concept of the specificity of psychosomatic diseases (Alexander) is being differentiated at the time. In order to clarify some aspects of this problem, we want to investigate whether types of self-rating of normal persons differ from those of patients with bronchial asthma. In a second step we shall examine whether those types of self-rating can be found also in expert rating and third the differences between the two groups concerning their help-seeking behavior. For the purpose of this investigation the data of 135 patients with bronchial asthma (who had been investigated at the Heidelberg University Medical Department between 1979 and 1982) and of 330 persons of the Mannheim Cohort Study (who are a representative sample of the average urban population) have been reanalyzed. By means of the Freiburg Personality Inventory (FPI) data cluster analyses have been done. Evaluated by a group of 5 (5-cluster solution) the patterns of self-rating of patients with bronchial asthma do not differ significantly from those of normal persons. They had a high correlation to the expert rating and to other social-medically important outer criteria. The results indicate that the specificity of psychosomatic patients in relation to normal persons is not very convincing in a pattern of self-rating on the level of the FPI. Therefore, further research in this field seems to be necessary.

Adult↗
PubMed1991

[Prognosis and spontaneous follow-up of psychological health and psychogenic disease].

Being able to look ahead, being able to make a correct prediction of events and developments has been of great interest to mankind since biblical times and with good reason. Due to his profession one expects from a doctor that he can make a prognosis. In the realm of psychogenic illnesses or of healthy persons certain barriers arise because of the lacking epidemiologic knowledge. We had to overcome these barriers in our cohort study conducted in Mannheim: In a random sample of 600 adults from a mostly healthy population, after conducting thorough psychoanalytic interviews a prognostic judgment was given for each person regarding the further course of psychic health or psychogenic illness (diagnosed for 26% of the persons). The spontaneous course and the accuracy of the prognosis was reexamined after three years. The quota of accuracy as well as occurring problems and considerations and a case oriented analysis of the prognostic misjudgements are discussed.

Adaptation, Psychological↗
PubMed1991

[Aspects of the development and sex specific prevalence of psychogenic diseases in children and adults in relation to genetic and environmental factors].

We investigated a sample of one hundred twins as to their neurotic disturbances in childhood and adulthood. The hereditary factor was of greater effect with the continuing neuroses of childhood than with the weakening neuroses in childhood. But a certain effect of the hereditary factor could not be denied with neuroses manifesting themselves only in adulthood. According to our results the hereditary factor in childhood is not stronger than in adulthood, with adults it is as effective. Particular neurotic symptoms show influences of the hereditary factor in respect to depressive, maladaptive oral and maladaptive aggressive disturbances of behavior and difficulties in forming interpersonal relationships. In respect to stuttering, disturbances of the urogenital system and intelligence and occupational development a certain hereditary factor is very probable. Sex influences also have a certain effect: Behavioral disorders in childhood are found in the male sex, the female sex rather shows psychic symptoms.

Adolescent↗
PubMed1991

[Genetic determinants in anorexia nervosa. Results of twin studies].

Contrary to many widely discussed theories of anorexia nervosa the conclusive human genetic results of research with twins have been almost totally ignored and individual casuistry has often been misinterpreted. The two twin-series studies at hand (Crisp et al./London and the author)--totally independent of each other and compiled during the same time period--speak unmistakably for a great genetic determination and genesis of anorexia nervosa. The AN-twin pairs compiled by the author over a period of 30 years are described here.

Anorexia Nervosa↗
PubMed1990

Training and postgraduate training in psychosomatics and psychotherapy in the Federal Republic of Germany today.

The training of medical and psychological students at the universities is completely separated. The postgraduate training to become a psychosomaticist, psychotherapist, or psychoanalyst again joins the colleagues of the two branches separated since Descartes and W. Wundt. The curricula and the quantitative result, i.e. the numbers of physicians and psychologists in the FRG, will be described here.

Cross-Cultural Comparison↗
PubMed1990

[A 20-year follow-up study of a sample of 50 pairs of twins with neurotic-psychosomatic disorders].

As part of a research project, examination was made of a sample of 50 pairs of twins (21 pairs of identical twins, 16 pairs of non-identical twins of the same sex, and 13 pairs of male-female twins [n = 100 test persons]) between 1963 and 1969 and again recently after a period of 20 years. The index twins were drawn from among the patients who made use of the services of an out-patient psychotherapeutic clinic, and they were determined to be either psychoneurotic, character neurotic, or psychosomatically ill. The question examined was again one of nature vs. nurture. Identical twins showed a significantly higher similarity with regard to the seriousness of their neuroses and the manifestation of neurotic symptoms than did non-identical twins. Noticeable similarities existed in cases of depressive disturbances, disturbances of oral and aggressive behavior, and disturbances of interpersonal contact. With regard to the influence of variables in the environment, we examined the effect of factors in early childhood on neurotic development. Lack of a reference person, a negative attitude on the part of parents toward the child, etc., frustration within and outside the family have an effect on the manifestation of neuroses and on the course of their development. The influence of early childhood factors on the degree of neurotic disorder is still to be noted in the current point prevalence.

Adult↗
PubMed1989

The epidemiology of psychogenic disorders and consequences for prevention.

After discussing social issues of epidemiologic research on neurotic, character and psychosomatic disorders, we outline the main results of a field cohort study on 600 representative adults of Mannheim, a West German industrial city. According to ICD 300-307 (WHO 8th revision) and to a quantitative case definition clinically based on the severity of the symptoms we find an overall case rate of 26% in which females prevail over men by a ratio of approximately 2:1 and the rate of lower social class members over that of higher ones. We then turned to conclusions of our research for matters of primary and secondary prevention. Concerning primary prevention of psychogenic diseases life circumstances during childhood proved to be relevant as predisposing variables and risk factors often indicating poor emotional relationships between the child and its caretakers. Furthermore, we deal with protective factors preserving mental and physical health in spite of heavy burdens during childhood. Turning to secondary prevention we examine risk factors in present life, the importance of the lay system, and the influence of life events as well as the true demand for psychotherapy.

Adult↗
PubMed1988

[Life events, coping and social support: attempt at integration from the psychoanalytic viewpoint].

In the Federal Republic of Germany, few attempts have been made to subject psychoanalytical theories of illness to empirical examination using the modern methods of science. There are also very few established connections between these theories and recognized socio-psychological concepts, and theoretical constructs that are in fact quite similar have thus led a separate but parallel existence because of differences in terminology. In our epidemiological research project (begun in 1978), we concentrate on the observation of psychic health and/or psychogenic illness as influenced by factors of personality and of symptom-causing conditions, drawing on the methods of socio-psychological research. In this study, we present 1) our results from the areas "Life-events", "Coping", and "Social support" and 2) a quantification of the pathogenic influence of these three factors based on regression analysis; finally, 3) we try to establish the connection to psychoanalytic concepts of symptom-causing temptation and failure situations and to ego-related models of defense and adaptation.

Adaptation, Psychological↗
PubMed1987

[Inpatient psychotherapy in West Germany. Sociocultural determinants, developmental stages and current status, international comparison].

In the Federal Republic of Germany, stationary psychotherapeutic treatment of the psychogenically ill in independent institutions has undergone and expansion without international parallel in the last few decades. This development is based on a number of particular sociocultural circumstances that have combined to exercise optimal influence. A review of the situation--it is estimated that there are ca. 5,000 beds for psychotherapeutic cases--and an international survey supplement the analysis of an area of care that has developed parallel to out-patient psychotherapy.

Cross-Cultural Comparison↗