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Biomedical subjects

J Willi

Publications and source records attributed to J Willi.

At least 19 recordsLinked to original sources
PubMed2001

Bilateral osteonecrosis of the talus and "standing obsession" in a patient with anorexia nervosa.

METHOD: We report a case of a 24-year-old woman with anorexia nervosa (AN), obsessive-compulsive disorder (OCD), and osteoporosis. During 8 years of illness, her body mass index (BMI) fluctuated between 10 and 13,5 kg/m(2). She developed hyperactivity and the habit to stand for all daily activities. She did not allow herself to sit at any time, she had "standing obsession." A few weeks after her admission to an inpatient unit for eating disorders, she reported pain in both ankles. Results and Discussion The rheumatological diagnosis was bilateral osteonecrosis of the talus and generalized osteoporosis. The latter and excessive biomechanical stress could be interpreted as the cause for this serious and irreversible bone destruction. The following case shows how the psychiatric comorbidity of a patient suffering from an eating disorder with a chronic course can lead to severe somatic complications.

Adult↗
PubMed2000

[Catamnestic study of ecological brief therapy].

Ecological brief psychotherapy has been practised at the Psychiatric Outpatient Clinic at the University Hospital Zurich since 1990. The aim is to use the development-oriented challenges posed by important others in the therapeutic process. The effectiveness of this form of therapy is investigated by reviewing the outcome of 28 completed treatment cases. While results at completion of therapy come up to the expectations, the long-term results were surprisingly positive. 96.4% of those surveyed reported they felt considerably better at final assessment 1 to 6 years after the therapy than they did at the beginning. Positive changes continued after the completion of therapy. We presume that our coevolutive focus brought resolution of blocked developmental steps in relationships that further stimulated changes that continued after the conclusion of therapy, even without further therapeutic support. Furthermore, the treatment effects provided by ecological brief psychotherapy apply to personality disorders as well.

Adult↗
PubMed2000

Psychotherapy of panic syndrome: focusing on ecological aspects of relationships.

Cognitive Behavioral Therapy (CBT) has been shown to be an effective symptomatic treatment for panic attacks; however, this paper recommends complementing it with an approach based on an interactive ecological model. The approach is based on the thesis that a panic syndrome can occur if patients block an impending and/or already initiated development of their relationships, especially involving partners or work. The case may be that, over a period of years, phobic attitudes and behavior described further in the text have enabled patients to maintain a socially positive shaping of their personal niches. Later, phobic avoidance behavior is no longer adequate due to the requirements of the new stage of life. Unconsciously, patients configure an outer relationship situation that demands of them the realization of the impending step in development. Therapy should utilize this relationship configuration.

Adult↗
PubMed1999

[Investigation of personal niche as basis of supportive psychotherapy].

According to the ecological theory of Willi 1996, people create and maintain their psychic wellbeing through constant shaping of their environment, i.e. setting up a personal niche. The personal niche in turn responds to, guides and challenges further personal development. This study explores what kind of solutions single patients with psychiatric invalidity can find in order to form their environment as a niche in which they may develop effectiveness and use it for their psychic regulation. 30 people were questioned with a semi-structured interview: they were patients of a psychiatric out-patient's clinic, living alone and psychiatrically invalidated (2/3 with schizophrenia of the residual type). The results were ranked after their increasing demands in a relational and in an activity inventory. The more relationship is based on mutuality expectations of others, personal disclosure and binding the more the subjects feel overstrained. The investigation of these inventories serve as a technical aid in supportive psychotherapy.

Adaptation, Psychological↗
PubMed1997

[In the gray area between body, psyche and social difficulties. II: Psychiatric assessment of somatoform disorders (exemplified by chronic pain patients].

Medico-legal assessment for long-term disability benefits in patients with mainly somatoform pain disorders is in increasing demand. Since impairment does not explain the loss of function in somatoform disorders, the expert must determine to what extent the patient is able to cope more actively with pain in order to attain a higher level of functioning. Consistency of behavioral signs, flexibility and initiative in the way of coping are helpful criteria in this respect. Special attention is given to problems in the assessment of migrants with these disorders. We strongly support the concept of an interdisciplinary approach in medico-legal assessment. Postgraduate medical training in this field should receive greater attention accordingly.

Disability Evaluation↗
PubMed1997

[In the grey area body body, psyche and social difficulties. I: New developments in diagnosis and therapy of somatoform disorders (exemplified by chronic pain patients)].

The so-called psychosomatic or functional conditions (notably somatoform pain disorders) often cause difficulties in diagnostic classification, clinical management and assessment of disability. Recent trends in diagnosis are reviewed. We describe our first clinical experience of interdisciplinary evaluation of pain patients by functional capacity evaluation and an ergonomically oriented rehabilitation program. This interdisciplinary approach could constitute a new field of close collaboration between physiatry/physical medicine, physiotherapy and psychiatry.

Adaptation, Psychological↗
PubMed1997

The significance of romantic love for marriage.

In this study, 605 subjects were asked about romantic love and marriage. Married people differentiated themselves from single people with stable partners and divorced people with new partners by more frequently living together with their great love, more reciprocity in that love, and less disappointments in love relationships prior to the current relationship; but they also described themselves as less happy and satisfied than the single and divorced respondents, particularly with regard to tenderness, sex, and conversation with their partners. Independent of marital status, those who were greatly in love with their partners describe themselves as happier. Love at first sight, relative to a gradually developing love, nevertheless, did not have a worse prognosis for happiness in marriage. Being in love seems to be of greater importance for the prognosis of the marriage than marital happiness and satisfaction.

Adolescent↗
PubMed1994

[The co-evolutional focus in individual, couple and family therapy].

A concrete formulation of focus is proposed that in structure and use is suitable for individual as well as couples and family therapy. The concept of coevolution (Willi 1985, 1991) forms a basis for the supposition that important personal developments are realised in human relationships. The development of one person is challenged, taxed, or hindered by the development of other persons. The formulation of a coevolutional focus consists of four steps: 1) The context of the relationship in which the current conflict emerges; 2) The identification of delayed stages of development; 3) The personal and interactional conditions which block this development; 4) Concrete changes which make the progress in the intended development recognizable. The focus in couples and family therapy integrates the impending development of the participants in their collusive interactions.

Adolescent↗
PubMed1994

[People in divorce and their ambivalence: initial use of a newly developed couples inventory].

It has been reported that intact internal, external and social accommodation is related to a stable partnership between men and women. Every partnership, however, is also characterized by a certain potential towards separation that may develop despite of the named stabilizing factors. This led to the question of how the accommodation is constituted in men and women during separation. A written questionnaire was, therefore, sent to a total of 35 men and women in separation. The Bradburn inventory was used to define the well-being of the volunteers in relation to a representative sample. Using a newly developed inventory, a number of items had to be rated twice: once to reflect the condition at the beginning of the partnership and once to reflect the situation during the last year. In addition, the relative contribution of a particular item in favor or against separation was asked. The Bradburn inventory shows that the general well-being of the test sample is more impaired than that of the representative sample. The evaluation of the 80% returned questionnaires revealed worsening of all items. Most important reasons to finish the partnership were i) the lack of verbal communication, ii) extramarital affairs, and iii) the impression that the partnership limits the personal development. Reasons to continue the partnership were different between those who initiated the separation and those who were left: The initiators predominantly mentioned structural factors such as financial situation, living conditions and care for children, whereas the non-initiators predominantly mentioned internal qualities of the partnership.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Couples therapy using the technique of construct differentiation.

A central problem in couples therapy is the clients' tendency to persist in endless and fruitless alternation between attacking the partner and justifying themselves. The technique of construct differentiation described in this article has proved helpful in coping with this situation. In three clearly structured steps, the therapist explores the personal constructs of each partner in the presence of the other. Instead of concentrating in the usual way on circularity of thoughts, feelings, and behavior, the partners are hindered from interacting and are confronted by the therapist's questions concerning their own inner process, independently of that of the partner. By becoming aware of their own ambivalent constructs and those of the partner, the eagerness to convert the partner to their own point of view can be reduced, and the construct system of each partner can be enriched by the other's constructs. Construct differentiation proves especially useful in the treatment of power struggles and narcissistic collusions.

Adult↗
PubMed1992

[Psycho-ecologic aspects of defense mechanisms].

Classical defense mechanisms are used not only intraindividually to strengthen a threatened ego-Organization, but also between individuals to stabilise endangered social relationships. According to a psychoecological way of thinking, any person has an existential need of productive, ongoing, mutual exchange in his or her social niches, in particular in those situations in which the inner equilibrium is threatened. Social relationships are used to support the threatened person in the use of classical defense mechanisms. People close to the individual have an important influence on reinforcing or weakening of the intrapersonal defenses, and therapists have to learn to take this into account.

Adaptation, Psychological↗
PubMed1991

Exploring the doctor-patient relationship reduces staff stress and enhances empathy when caring for AIDS patients.

At our AIDS outpatient clinic we presently care for more than 1,200 HIV-infected patients. All physicians in this unit have participated for 1 year in a case work group supervised by a liaison psychiatrist. The doctor-patient relationship, the assessment in the case work group and the ensuing influence on perception and behavior are demonstrated by 3 cases. Different issues challenge the doctor-patient relationship: the serious prognosis of predominantly young AIDS patients; isolation and stigmatization of patients; fear of contagion, and questions of confidentiality regarding contact tracing. Reflection upon the doctor-patient relationship improves communication skills and increases empathy towards AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Positive and negative consequences of voluntary HIV-antibodies test].

Clinical observations and empirical findings with regard to possible negative and positive consequences of the HIV-Antibody-Test are discussed. It was concluded that at the present time we should not recommend the test generally for all people, but rather suggest the way of test-counselling. Results of a pilot study demonstrate that during anonymous testing a conversation about the preceding risk behavior is possible with most of the testes. Recent discussions about aids with the partner or close friends had an important trigger function in their decision to ask for the HIV-Antibody-Test.

AIDS Serodiagnosis↗
PubMed1990

Update on the epidemiology of anorexia nervosa in a defined region of Switzerland.

In this follow-up investigation, the authors studied all Swiss women in the canton of Zurich who developed anorexia nervosa between ages 12 and 25 years and who were hospitalized for the first time with this diagnosis between 1983 and 1985. Data were compared with those from an earlier study, which focused on the periods 1956-1958, 1963-1965, and 1973-1975. The incidence of anorexia nervosa did not increase significantly during 1983-1985 compared to 1973-1975, in contrast to the constant increase found between 1956 and 1975. However, the more frequent use of vomiting and abuse of laxatives in 1983-1985 may indicate an increase in cases with mixed features of anorexia nervosa and bulimia.

Adolescent↗
PubMed1989

[Psycho-ecologic aspects of supportive psychotherapy].

Supportive psychotherapy is the most frequently applied therapy by practitioners. However, this form of therapy has not been properly conceptualized and theoretically founded yet. Psychoecological terms could be appropriate to integrate the intuitive and unsystematic strategy in an theoretically founded framework. The term "social niche" refers to a person's affective field of action. Being responded to by the members of one's own niche is what constitutes the significance, the function and the role of the respective person. In situations of psychic disorder a person's ability to construct a corresponding niche, and interact and perform within it is severely disturbed. Defense mechanisms are mobilized in order to maintain the relations within the niche. In the case of decompensation a niche is formed, which is reduced to the subject of illness. Some ecologically founded suggestions are given for practical use.

Humans↗
PubMed1988

[Bone loss in female patients with anorexia nervosa].

Osteoporosis is occasionally seen in young women with episodes of anorexia nervosa. To study anorectic osteopenia we have examined 10 patients aged 18 to 37 years before, during and after treatment. Treatment consisted of hospitalization for correction of underweight by tube feeding and subsequent psychotherapy. Bone-density measurements performed with high-precision, low-dose, quantitative computed tomography of the distal radius and the distal tibia before treatment showed an age-dependent pattern. Linear regression suggests a trabecular bone loss of approximately 3% per year. This loss might be caused by low estrogens, because all patients were amenorrheic. After tube-feeding periods of 27 to 89 days (5 patients), trabecular bone density of the tibia was further reduced by 10.3% (range 6-13%) below pretreatment values. One year later average trabecular bone diminution was 17.3% (range 8-28%). Such rapid bone loss may cause osteoporosis within a few years, and treatment is therefore required for prevention of this skeletal deterioration.

Adolescent↗