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Biomedical subjects

Herbert Fliege

Publications and source records attributed to Herbert Fliege.

17 recordsLinked to original sources
PubMed2006

Three assessment tools for deliberate self-harm and suicide behavior: evaluation and psychopathological correlates.

OBJECTIVE: The aims of this study are to adapt two validated self-report questionnaires of deliberate self-harm and suicidal behavior to German, to investigate their psychometric properties and agreement with clinician-administered ratings, and to examine their psychopathological correlates. METHODS: The Deliberate Self-Harm Inventory [Gratz KL. Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. J Psychopathol Behav 2001;23:253-263] and the Self-Harm Behavior Questionnaire [Guttierez PM, Osman A, Barrios FX, Kopper BA. Development and initial validation of the self-harm behavior questionnaire. J Pers Assess 2001;77:475-490] were completed by 361 patients hospitalized for depressive, anxiety, adjustment, somatoform, and/or eating disorders. A clinician-administered rating scale of self-destructive behavior was included. Psychopathological variables were assessed by standardized questionnaires. RESULTS: The self-report questionnaires demonstrated good reliability (alpha=.81-.96, split-half r=.78-.98, test-retest r=.65-.91). Reliability of the clinician-administered ratings was acceptable (interrater kappa=.46-.77, test-retest kappa=.35-.48). Intraclass correlations (ICC=.68) for all three instruments were satisfactory. Rates of self-harm and associations between self-harm and suicidal behaviors are reported. The findings support the hypotheses of a higher degree of psychiatric symptomatology in patients with self-harm behavior compared to those without. CONCLUSION: The two questionnaire adaptations are reliable and valid self-report scales for the assessment of self-harm and past suicidal behavior.

Adolescent↗
PubMed2006

[Standardized diagnosing: computer-assisted (CIDI) diagnoses compared to clinically-judged diagnoses in a psychosomatic setting].

BACKGROUND: Within the past two decades, there has been an increasing trend towards the use of empirically-based, standardized instruments to diagnose mental disorders. The purpose of this study was to investigate the congruence between clinically-derived and standardized computerized diagnoses using the Composite International Diagnostic Interview (CIDI) in a psychosomatic setting. PATIENTS AND METHODS: N = 230 inpatients treated at the Department of Psychosomatic Medicine, Charité Berlin, were diagnosed for mental disorders by experienced clinicians and by the CIDI according to the diagnostic criteria of ICD-10 and DSM-IV. RESULTS: Congruence between computerized and clinically-derived diagnoses for all mental disorders was fair to poor (kappa = 0.0 - 0.33). The diagnostic congruence of somatoform (F45), anxiety (F40 - 41), depressive (F32 - 34), eating (F50) and dissociative disorders (F44) and disorders due to psychoactive substance use (F10 - 19) was fairly low (kappa = 0.19 - 0.33). Diagnostic congruence of diagnoses of reactions to severe stress (F43) and obsessive compulsive disorders (F42) was particularly poor (kappa = 0.0 - 0.01). CONCLUSION: Overall diagnostic congruence between computerized and clinical diagnostics was unsatisfactory. Thus, the validity of computer-assisted standardized interviews - like the CIDI - is questionable in a psychosomatic setting.

Adult↗
PubMed2006

[Evaluation of the effectiveness of psychosomatic in-patient treatment on the basis of subjective and objective criteria].

OBJECTIVES: The effectiveness of psychosomatic in-patient treatment was evaluated using patients' subjective health ratings and objective data provided by health insurance companies. Associations between subjective and objective criteria were investigated. METHODS: 318 patients participated in the study. They completed questionnaires on physical complaints, moods and everyday functioning upon hospital admission, at discharge and at one-year follow-up. Insurance companies provided data for 140 of these patients (44 %). Sick leave and the utilization of in-patient treatment were assessed for a period of two years before and two years after psychosomatic treatment. RESULTS: As expected, subjective health status improved. The utilization of in-patient treatment decreased in both years after treatment compared to the year before. Sick leave increased in the first year after treatment but decreased significantly below the base level in the second year after treatment. Self-efficacy expectations and being employed were found to be predictors for long-term reduction in the length of in-patient treatment. Subjective and objective criteria were only slightly correlated. CONCLUSIONS: Sick leave and utilization of in-patient treatment were found to increase considerably in the year before psychosomatic treatment. Therefore, pre-post differences over the entire period were only marginal. The change in subjective criteria was more immediate, while changes in some objective parameters were delayed. Both subjective and objective criteria should be included in outcome studies.

Activities of Daily Living↗
PubMed2005

Determinants of the quality of life of patients with congenital heart disease.

OBJECTIVE: The improvement of the quality of life of chronically ill patients has become an important goal in treatment. However, it is seldom taken into account that many other factors, in addition to somatic factors, have an influence on the quality of life of patients. Using patients with congenital heart defects as an example, we examined the relative significance of biological factors, compared to psychological and social factors, for the various quality of life dimensions. RESEARCH DESIGN AND METHODS: One hundred and eleven patients (aged 33+/-12 years) with different degrees of cardiac dysfunction were examined (NYHA 0: 2 I: 56, II: 38, III: 13, IV: 2). All patients for whom there was no contra-indication underwent a treadmill ergometry in order to determine their level of cardiopulmonary functioning (peak oxygen consumption: VO2max). All patients were asked to fill out questionnaires concerning their quality of life (WHOQOL-Bref), their cardiac complaints (Giessener Complaint Questionnaire GBB), their personality traits (Giessen Test GTS), and the social support they experience (Social Support Questionnaire SOZU-k22). The data were analyzed using a linear structural equation model (SEM). RESULTS: In all aspects but the social domain, the HRQL of CgHD patients was significantly diminished compared to the normal population. The SEM proposed was valid, showing good indices of fit (chi2 = 1.18; p = 0.55; AGFI = 0.92). The level of cardiopulmonary functioning was most significant for the reporting of specific cardiac complaints (beta = -28) and for the physical component of the general HRQL (beta = 32), although the former was also influenced by a depressed disposition (beta = -0.20) and the extent of social support experienced (beta = 0.18). The objective findings, however, had virtually no individual significance for the psychological (beta = 0.09) and social domains (beta = -0.02). These HRQL domains are primarily influenced by depressive personality traits (beta= -26/-0.16) and the social support experienced (beta = 0.51/0.51). CONCLUSIONS: The patient's organic dysfunction primarily determines illness-specific complaints but has little relevance for the psychological and social aspects of the HRQL. These aspects are predominantly determined by the patient's depressive disposition and by the experienced social support. A successful therapy should therefore take biological as well as psycho-social determinants of the quality of life into account.

Adult↗
PubMed2005

Development of a computer-adaptive test for depression (D-CAT).

Depression is one of the most prevalent mental health problems and measuring depressive symptoms becomes increasingly important in science as well as medical practice. Computer Adaptive Tests (CAT) based on the Item Response Theory (IRT) promise to enhance measurement precision and reduce respondent's burden. Our aim was to develop a CAT application to measure depressive symptoms. Three thousand two hundred seventy psychosomatic patients answered an overall of 11 mental health questionnaires at the University Clinic in Berlin. Three independent reviewers rated 144 items out of these questionnaires as indicative of depressive symptoms. All items underwent six empirical steps to analyze unidimensionality, local independence and item discrimination. Finally 64 items could be used to calculate item parameters applying a Generalized Partial Credit Model (GPCM). CAT scores were estimated using an 'expected a posteriori' algorithm (EAP). Two simulation experiments showed that for theta values within the range of 2SD around the mean (98% of the cases), the latent trait can be estimated out of approximately six items with a predefined standard error of [Symbol: see text] 0.32 (reliability rho [Symbol: see text] 0.90). The CAT-scores correlated high with scores of all depression items (r = 0.95), with the Beck Depression Inventory (r = 0.79) and with a CES-D 8 item short form (r = 0.76). We conclude that the Depression-CAT measures depressive symptoms with high precision and low respondent burden.

Adolescent↗
PubMed2005

Autodestructive syndromes.

BACKGROUND: The phenomenon 'autodestructive behaviour' is becoming an increasingly serious disease and cost factor in a wide range of medical fields. The present paper presents a survey of the literature on autodestructive behaviour, excluding psychotic, substance-induced or organic brain disorders. Starting out with a conceptual overview, the paper goes on to look into the epidemiology of autodestructive behaviour and the forms in which it manifests itself. METHOD: A literature search was conducted in Medline, Psycinfo and Psyndex using the search terms 'artifact', 'artificially induced', 'autodestructive', 'self-mutilation', 'factitious', 'self-harm', 'self-induced', 'self-inflicted', 'self-injuring' and 'self-mutilation' for the period from 1977 to 2003. RESULTS: Five of a total of 18 empirical studies describe the simultaneous occurrence of direct and indirect forms of autodestructive behaviour. Reported prevalence rates range from 0.032% to 9.36%. The ratio of females to males was found to be 2:1 (average age: 31.5 years; SD: 9.3 years); in contrast, the gender ratio was reversed for Munchausen's syndrome. The case history data presented are patchy and differ in terms of their priorities. We found a large number of codiagnoses, which seems to indicate that personality and dependence disorders, or substance misuse, are characteristic of both direct and indirect forms of autodestructive behaviour. CONCLUSIONS: The task at hand is to use a yet-to-be-developed nomenclature and adequately operational diagnostic criteria to work out standardised survey instruments that do justice to the heterogeneity of this disorder complex.

Comorbidity↗
PubMed2003

[Personality and donor-recipient relationships of potential donors before living donor liver transplantation--diagnostics with the repertory-grid technique].

BACKGROUND: Living-donor liver transplantation (LDLT) is developing into an established therapy for terminal liver diseases in adults. Potential donors are faced with the risk of postoperative complications and are subject to a high level of psychological pressure and ambivalent feelings. Our assumption is that ambivalent feelings before donation are crucially influenced by the personality and the quality of the donor-recipient relationship. In highly motivated donors we expected a positive description of the recipient and a similarity in the characterisation of the donor and recipient. METHODS: 58 potential living donors were evaluated between March 2000 and June 2001. On the basis of the clinical interview 10 were rated as unsuited for donation. Among those potential donors assessed as unsuited, we found a high level of ambivalent feelings. For 50 potential donors we gained a set of completed psychometric diagnostic questionnaires. A Repertory-grid investigation was conducted with a total of 28 potential donors. Seven of them were not recommended as living donors. The relationship between donors and recipients was analysed concerning constructs that were most important to the characterisation of the donor or recipient. By means of inter-element distances self-concept of donors and donor-recipient relation were analysed. RESULTS: Ambivalent candidates who were not recommended as living donors tended to describe the recipient negatively (selfish, carping, and unable to take criticism) and did not show a similarity in the characterisations of self and ideal-self. Whereas the highly motivated candidates were marked by a closeness of self and ideal-self concepts. Both groups saw the recipient as indifferent. CONCLUSION: Closeness between self and ideal-self-indicating satisfaction with the decision to donate seems to be one suitable criterion to distinguish between highly motivated potential donors on the one hand and ambivalent candidates on the other hand. Another criterion appears to be a description of the recipient that indicates either a functioning or ill-functioning communication between donor and recipient with respect to the donation.

Adult↗
PubMed2003

[Disturbed regulation of self-esteem in patients with overt versus covert self-destructive behaviour].

OBJECTIVES: According to psychoanalytic models self-harming patients are characterised by an unstable self-system and a disturbed regulation of self-esteem. This is presumed to be denied or dissociated to a greater degree by those who harm themselves secretly (factitious patients) as compared to those who show open self-harm. It is hypothesised and empirically tested that self-destructive patients have more profound disorders of narcissistic self-regulation than patients without self-destruction, and that this should be more evident in patients with overt self-destructive behaviour. METHODS: The sample consists of 354 psychosomatic patients, 32 of whom demonstrated self-destructive behaviour (18 exclusively overt and 6 exclusively covert types of behaviour, according to Willenberg et al.). The narcissism inventory was applied. RESULTS: Self-destructive patients showed higher levels on the "threatened self"-dimension than psychosomatic patients without self-harm. Overtly self-harming patients showed a higher degree of narcissistic self-regulation than covertly self-destructive patients. CONCLUSIONS: This supports theoretical assumptions of a disturbed regulation of self-esteem in self-destructive patients, especially in overtly self-harming patients.

Adolescent↗
PubMed2002

[Predicting long-term outcome of in-patient psychosomatic treatment].

Abstract. The outcome of in-patient psychosomatic treatment was evaluated by longitudinal assessment at hospital admission, discharge, and 1-year-follow-up. Out of n = 1829 patients, n = 712 responded (38.9 %). Response rates co-varied with duration of in-patient treatment. Responder-analyses characterise the sample as fairly representative. Outcome criteria included standardised measures of complaints, mood quality, global quality of life, life satisfaction, everyday functioning, and social integration. Disease-related parameters (duration of illness, medical certification, number of doctors consulted, number of somatic resp. psychosocial diagnoses) and generalised outcome expectancies (self-efficacy, optimism, pessimism) were included as predictors. Patients' retrospective estimations at follow-up as well as longitudinal assessments show a successful and mostly stable therapy outcome. Negative moods and complaints show a new increase at follow-up, though, still remaining below the level at hospital admission. Although there is much accordance among the diagnostic groups, patients with anxiety disorders (ICD-10: F40/41) and patients with adaptation disorders (F43) show distinctly varying courses. Regression analyses yield specific correlations between disease-related parameters and long-term outcome: Duration of treatment does not predict treatment outcome. The number of somatic diagnoses is a predictor of complaints, the number of psychosocial diagnoses a predictor of negative moods at follow-up. Pessimism and - to a lesser degree - self-efficacy prove to significantly predict numerous outcome criteria. Generalised expectancies should be considered in the process of prognosis and differential indication.

Follow-Up Studies↗
PubMed2002

T-cell immune parameters and depression in patients with Crohn's disease.

GOALS: The causes of Crohn's disease (CD) are still considered to be unknown. It is likely that an immune defect leads to an increase in T helper 1 (Th1) cytokine responses, which may then contribute to the characteristic morphologic changes. Increased values in distinct immune activation parameters connected with a Th1 immune response have also been found in patients who are depressed. Because various clinical observations have asserted that a depressive disposition may have some connection with the development of CD, we examined whether a relationship exists between T-cell activation parameters and depressive personality characteristics in patients with CD. STUDY: Seventy-one patients (62% women; age, 38 +/- 13 years) with CD (23 with CD Activity Index [CDAI] >150 and 48 with CDAI < or =150) were included in this study. Sixty patients were re-examined after 4.4 +/- 1.8 months. The T cell parameters CD2, CD3, CD26, CD28, and CD95 and the activity of dipeptidyl peptidase IV (DPP IV) in serum were examined in the peripheral blood. The patient's subjective health status was assessed by means of a standardized psychometric instrument (Short-form Inflammatory Bowel Disease Questionnaire [SIBDQ]). The presence of various characteristics indicative of a depressed mood was also assessed (Center of Epidemiological Studies-Depression Scale, Berliner Stimmungsfragebogen), as well as indicators of a personality disposed to depression (Giessentest) and a depressive illness coping strategy (Freiburger Krankheitsverarbeitungs-Fragebogen), all using the above-mentioned standardized instruments. RESULTS: The immune parameters connected with the activation of Th1 (CD25+, CD25+/CD26+) are increased in patients, depending on the stage of illness. In addition, DPP IV activity was significantly lower in patients with an active disease, as was their subjective health status (SIBDQ). A connection with an indicator of mental depression could not be found. CONCLUSION: The observed changes in immune parameters support the idea that morphologic changes could be connected with an increased Th1 response and that DPP IV activity could play an immunomodulatory role. A relationship between the measured immune parameters and individual characteristics of depression could not be found.

Adult↗
PubMed2002

The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control.

OBJECTIVE: The primary goals in treating patients with diabetes are maintaining blood glucose levels as close to normal as possible and making a relatively normal quality of life achievable. Both of these goals are influenced by a multitude of somatic and psychological factors that should be seen as building a complex network. We examined whether a mathematical model can be construed that can depict the relative significance of each factor for achieving these treatment goals. RESEARCH DESIGN AND METHODS: A total of 625 patients from 32 different treatment facilities were examined (224 type 1 and 401 type 2 diabetic patients) using HbA(1c) values (high-performance liquid chromatography), number of secondary illnesses, and standardized questionnaires with respect to health-related quality of life (World Health Organization Quality of Life questionnaire), coping behavior (Freiburger Illness-Coping Strategies questionnaire), diabetes-specific knowledge (Test of Diabetes-Specific Knowledge), doctor-patient relationship (Medical Interview Satisfaction Scale), and personality characteristics (Giessen Test and Assessment of Beliefs in Self-Efficacy and Optimism). The analyses were carried out by means of a structural equation model. RESULTS: The model proved to be valid (chi(2) = 88.5, df = 76, P = 0.16), showing a sound fit (adjusted goodness of fit [AGFI] = 0.94). It explained 62% of the variance of the quality of life and 5% of the HbA(1c) values. Subjects characterized by strong beliefs in their self-efficacy and an optimistic outlook on life were more likely to be satisfied with their doctor-patient relationships. They demonstrated more active coping behavior and proved to have a higher quality of life. Active coping behavior was the only psychological variable significant for the HbA(1c) values. CONCLUSIONS: It was possible to illustrate the various factors involved and their mutual dependency and significance for the treatment goals. Belief in self-efficacy and active coping behavior appear to have the greatest relevance for achieving the primary treatment goals.

Blood Glucose↗
PubMed2000

[Self-destructive behaviour - occurrence and typological classification in an university psychosomatic unit]

The occurrence of self-destructive phenomena (direct self-harm; self-induced disease; self-harm delegated to medical staff) in all patients referred to the psychosomatic consultation service and all outpatients during 14 months and all discharged of the psychosomatic ward during 2 months (N=1057) is determined by the typological-descriptive assessment of Willenberg et al. (1997). Self-destructive behaviour was documented in n=79 cases (7.5%), in 40.5% of these on suspicion. 62% showed recurrent self-harm. In 15% there was a high risk to health, in 4% mortal danger. 51% hurt themselves overtly, 24% secretly. Direct self-harm occurred in 71%, self-induced disease in 48%, delegated self-harm in 35% of the cases (39% overlap). An average of 15 years passes between early precursor symptoms and the reference to the psychosomatic unit. Compared to the control group of psychosomatic patients, self-destructive patients are more often female (81%), younger, less frequently married (statistically confounded with age), more frequently medically certified and sick for more than one year. In sum, they have as many somatic diagnoses (M=0.75) but significantly more psychosocial diagnoses (ICD-10: F) (M=1.86 vs. M=1.40). Bulimia, addiction / substance abuse, and personality disorders proved to be more frequent co-diseases, anxiety disorders were underrepresented. Occurrence and relevance of self-destructive or facticious disorders are apparently underrated, so far. ICD-10 criteria are insufficient to cover all relevant types of self-destructive behaviour.

Journal Article↗
PubMedDate not supplied

Factitious disorders and pathological self-harm in a hospital population: an interdisciplinary challenge.

Factitious disorder, Munchausen's Syndrome, and deliberate self-harm have recently been conceptualized as different facets of self-destructive behavior. A descriptive typological classification has been presented by Willenberg et al., but has not yet been tested with a clinical sample. The instrument distinguishes between direct self-harm (e.g., self-inflicted wounds), self-induced disease (e.g., factitious fever), and indirect self-harm delegated to medical staff (e.g., repeated operations occasioned by feigned symptoms). All patients referred to the psychosomatic-psychotherapeutic liaison-consultation service or to the outpatients' department within 14 months (n = 995) and all patients discharged from in-patient psychosomatic-psychotherapeutic treatment within 2 months (n = 62) were assessed. Expert instruction and supervision were provided for the diagnosticians. The assessment was continued for a subsequent year, without special supervision (n = 1,058). Self-destructive behaviors were diagnosed in 7.5% of the cases in the first sample, with certainty (59.5%) or on suspicion (40.5%). In the subsequent sample without supervision, the rate reduced to 3.6%. Referrals had come from almost all clinical departments, including the emergency unit (26%), surgery, internal intensive care, endocrinology (9.5% each), neurology, infectiology, nephrology (7.1% each), dermatology, gastro-enterology, cardiology (4.8% each) and surgical intensive care (2.4%). The occurrence of pathological self-destructive phenomena is underrated when using only the ICD-criteria. The rate is influenced by diagnostic attention.

Adolescent↗
PubMedDate not supplied

The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples.

OBJECTIVE: The aim was to translate, revise, and standardize the Perceived Stress Questionnaire (PSQ) by Levenstein et al. (1993) in German. The instrument assesses subjectively experienced stress independent of a specific and objective occasion. METHODS: Exploratory factor analyses and a revision of the scale content were carried out on a sample of 650 subjects (Psychosomatic Medicine patients, women after delivery, women after miscarriage, and students). Confirmatory analyses and examination of structural stability across subgroups were carried out on a second sample of 1,808 subjects (psychosomatic, tinnitus, inflammatory bowel disease patients, pregnant women, healthy adults) using linear structural equation modeling and multisample analyses. External validation included immunological measures in women who had suffered a miscarriage. RESULTS: Four factors (worries, tension, joy, demands) emerged, with 5 items each, as compared with the 30 items of the original PSQ. The factor structure was confirmed on the second sample. Multisample analyses yielded a fair structural stability across groups. Reliability values were satisfactory. Findings suggest that three scales represent internal stress reactions, whereas the scale "demands" relates to perceived external stressors. Significant and meaningful differences between groups indicate differential validity. A higher degree of certain immunological imbalances after miscarriage (presumably linked to pregnancy loss) was found in those women who had a higher stress score. Sensitivity to change was demonstrated in two different treatment samples. CONCLUSION: We propose the revised PSQ as a valid and economic tool for stress research. The overall score permits comparison with results from earlier studies using the original instrument.

Abortion, Spontaneous↗
PubMedDate not supplied

Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice.

The authors surveyed physicians for frequency estimates of factitious disorder among their patients. Twenty-six physicians in independent practice and 83 senior hospital consultants in internal medicine, surgery, neurology, and dermatology participated. They completed a questionnaire including the estimated 1-year prevalence of factitious disorder among their patients. Frequency estimates averaged 1.3% (0.0001%-15%). The number of patients treated correlated negatively with frequency estimates. Dermatologists and neurologists gave the highest estimations. One-third of the physicians rated themselves as insufficiently informed. Frequency estimations did not differ by information level. The estimated frequency is substantial and comparable to earlier findings. Authors discuss clinical implications.

Cross-Sectional Studies↗