Biomedical subjects

Joachim Küchenhoff

Publications and source records attributed to Joachim Küchenhoff.

8 recordsLinked to original sources

PubMed2006

Interactional behaviour as a marker for screening patients with environment-related complaints.

BACKGROUND: Adequate assessment of symptoms of patients suffering from environmental illnesses requires appropriate procedures such as psychological and psychiatric diagnostics, medical screening and a thorough analysis of noxious environmental factors. The Basel pilot research project established a multi-methodological assessment procedure that meets these criteria. However, an exhaustive three-fold analysis is very costly in terms of both equipment and personnel, and hence the need for a heuristic approach and pre-screening persists. METHOD: The three-fold diagnostic approach was preceded by a structured psychodynamic interview; the findings were used to construct a new profile of the patient's interactional behaviour (IB) in conjunction with the interviewer's countertransference. The extent to which this new profile could predict the results of the multi-method assessment was then assessed. RESULTS: A low level of IB on the part of the patient significantly predicted the degree of stress and the extent of the psychiatric diagnosis, including personality disorders. A negative IB was associated with negative personality traits. Furthermore, a high level of IB implied more medical, but not more environmental, findings which could plausibly be related to the patient's complaints. CONCLUSIONS: Assessment of patients' IB in conjunction with one's own countertransference is very helpful as a preliminary heuristic approach and may lead to consequences for treatment and therapy. Therefore, the training provided for experts who deal with patients suffering from environment-related complaints should place more specific emphasis on assessing patients' behaviour and on incorporating information gathered from countertransference. Nevertheless, an interdisciplinary assessment including medical, psychological/psychiatric, and environmental expertise remains mandatory for adequate and satisfactory diagnosis of patients with environment-related complaints.

Behavior↗

PubMed2005

[Psychiatric, medical and environmental factors in patients suffering from environment-related disorders].

BACKGROUND: A multidisciplinary approach and a multi-modal methodology are needed to assess idiopathic environmental illnesses. SAMPLE: 61 patients took part in all diagnostic steps. METHOD: In the Basel pilot research project on environmental illness, a threefold diagnostic approach was established: patients had a medical and allergological examination, a psychiatric and psychological exploration and an environmental analysis of their homes. RESULTS: There is a clear psychological impact on environmental illness: 46 % of the symptoms could be traced back to psychological factors, and 18 % seemed to be influenced by them. Nevertheless, in 28 % more than one of the three dimensions was seen as important. Values within the self reporting questionnaires show high correspondence. Whereas patients and experts agree in many instances that there are psychological factors, they disagree in attributing clinical relevance to them. This discrepancy is helpful for explaining the difficulties therapists may encounter as to the patients' compliance. CONSEQUENCES: Environmental illness should be diagnosed and treated on an interdisciplinary basis including psychosomatic medicine.

Adult↗

PubMed2005

[Status, possibilities and limitations of therapies in psychosomatic day clinics].

During the past few years, several psychosomatic day clinics have been established. The goal of this paper was to research the programs these day hospitals offer, their general set-up, as well as their indication criteria. We surveyed 18 day clinics, which we had identified via internet. Most of the day clinics have the capability to treat between ten and twenty patients and work mainly with group concepts. Mean treatment duration ranges from 7 to 12 weeks. Although having patients with different diagnoses, most day clinics treat them together, while some day clinics concentrate on special diagnoses (eating disorders, anxiety disorders, personality disorders). Overall, the day clinics' main diagnoses, therapeutic programs, and treatment durations are comparable with those of in-patient hospitals in Germany. It appears that day clinic treatment is especially appropriate for patients who have difficulties in incorporating their experiences from an (in-house) therapy into the real world, as well as patients who have to care for family members (e. g. children) while in treatment. An enquiry to the federal states of Germany showed that, in the area of psychotherapeutic medicine, there are 324 day clinic places as well as 2,639 beds for acute inpatient treatment available. Six federal states, however, do not allocate beds for psychotherapeutic medicine in particular, but assign them to the area of psychiatry.

Day Care, Medical↗

PubMed2005

Psychosocial situation of living donors: moods, complaints, and self-image before and after liver transplantation.

BACKGROUND: Living donor liver transplantation (LDLT) has developed into an established therapy for terminal liver diseases. There is, however, little knowledge of the psychosocial situation of living donors. The aim of this study was to investigate the course of donors' moods, physical complaints, and self-image in the preoperative decision process and six months after surgery. MATERIAL/METHODS: Fifty-two potential donors were evaluated at the Charité Berlin. On the basis of the clinical interview, seven (13%) potential donors were not recommended for LDLT for psychosocial reasons. Twenty-six donors underwent liver resection and were re-evaluated six months after surgery. Donors' moods were investigated with the Berlin Mood Questionnaire (BMQ) and their physical complaints were assessed by the Giessen Complaint Questionnaire (GCQ). The Narcissism Inventory (NI-90) was used to assess their self-image. RESULTS: Potential donors who were not recommended for surgery showed significantly higher values for negative moods, physical complaints, and 'narcissistic rage". After surgery, donors' self-images were generally stabilized. Nevertheless, five donors (19%) showed high values for "threatened self" before and after transplantation, as well as high values for negative moods and complaints after LDLT. CONCLUSIONS: The resection of the right hepatic lobe holds promise of a good psychosocial outcome, with stable self-image and self-esteem for most donors. A minority of donors exhibited enhanced perception of distress and low self-esteem before and after surgery, which can easily be overlooked in the preoperative evaluation. A psychometric assessment of self-image before transplantation should be added to the clinical interview evaluation of potential living donors.

Adult↗

PubMed2004

Are environmental medicine problems relevant in Switzerland?

BACKGROUND AND AIM: In Switzerland, the prevalence of health problems attributed to environmental exposures is unknown, and views differ regarding its magnitude. In the present study we investigated the frequency of environmentally related health problems amongst the patients of Swiss sentinel physicians and assessed symptoms and suspected environmental exposures. METHODS: During 2002, nearly 250 "Swiss Sentinel Surveillance Network" physicians were asked to record the number of patients presenting with environmental health problems and to complete a questionnaire inquiring about suspected environmental exposures and health problems. Physicians offering "alternative" medical therapies also participated in the study. The results were compared with the experience of a Basel University pilot project which evaluated patients with environment-related health problems simultaneously from the medical, psychiatric and environmental viewpoint. RESULTS: 354 environment-related consultations were reported by 72 physicians, corresponding to 0.03% of all sentinel-physician consultations. There were considerable differences both within the group of Sentinella physicians, and between physicians offering "alternative" medical therapies and the Sentinella physicians, in the frequency of environmentally-related consultations, the character of the reported symptoms and the suspected environmental exposures. CONCLUSION: Overall, environmental medicine consultations in general practice were rare. However, experience of the environmental medicine pilot project showed that concerned persons seek help from various health care providers and from environmental agencies. Effective treatment should include counselling by medical, psychiatric and environmental professionals.

Environmental Exposure↗

PubMed2004

Symptoms attributed to the environment--a systematic, interdisciplinary assessment.

PROBLEM: To assess symptoms attributed to the environment from an interdisciplinary perspective and to evaluate the plausibility of the participants' individual theory of a causal relationship between exposure and health impairment. METHOD: We assessed the medical, psychiatric and environmental background in every participant in an environmental medicine project and discussed the explanatory value of our findings for each reported symptom. RESULTS: Every second participant had at least one symptom that could be plausibly explained by simultaneously occurring medical, psychological or environmental findings. In 40% of the participants the research team rated the association between an environmental exposure and the health complaints to be 'plausible'. Psychiatric disorders were frequent, but did not exclude environmentally caused symptoms. CONCLUSION: Only an interdisciplinary structure including medical, psychiatric and environmental expertise is likely to adequately diagnose and advise persons with environmentally related symptoms.

Counseling↗

PubMed2004

[Quantitative and qualitative analyses in patients with environmentally related disorders].

BACKGROUND: Diagnostics and therapy of environmentally related disorders are hampered by one-sided assumptions and by discrepancies between therapists' and patients' assessments of the disease cause. OBJECTIVES: Discrepancies between patient and expert opinions are examined as to (1) whether the sample can be classified in subgroups according to the convergence or divergence between self and expert rating, (2) which features and (3) which disorder-related behaviour and concepts characterize these groups. METHODS: Medical, psychopathological and environmental symptoms were assessed and their relative influence evaluated. Four subgroups were defined by differentiating between high and low psychological stress according to self and expert judgment, and then compared using statistical and qualitative methods. RESULTS: 61 patients were assessed and assigned to four different subgroups according to the number of psychiatric diagnoses, psychological conflicts, personality structure, environmental exposure and psychosocial integration. CONCLUSIONS: Diagnostics of environmentally related disorders must be based on interdisciplinary tools. Treatment should incorporate the individual patient's conception of his or her disorder.

Adult↗

PubMed2003

[Body image and mental structure--the ascertainment of body experience in psychodynamic diagnostics].

The present paper introduces a new method for diagnosing the body image and reference to the integrational level of personality structure. First the body image is defined using five criteria: consciousness, flexibility, intersubjectivity, representational links to thought contents, and level of structural integration of the personality. Using axis four of the Operationalised Psychodynamic Diagnostics (OPD) as a starting point, dimensions are defined and described that allow assessment of the body image according to structural dimensions of the personality. The structural diagnostics of the body image can serve as a basis for a new rating instrument of body image integration.

Adult↗