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Biomedical subjects

M Strack

Publications and source records attributed to M Strack.

14 recordsLinked to original sources
PubMed2003

Family representations in relationship episodes of patients with a diagnosis of bulimia nervosa.

The influence of the family on the development and the maintenance of bulimia nervosa can be seen both biologically and psychosocially. Genetic influences are discussed, but their effects do not explain the aetiology exclusively. Clinical observations and research findings support the role of family dynamics, family environment, and family functioning. In particular, a low level of cohesion, a lower degree of expressiveness, and more conflicts seem to characterize the family of patients with a diagnosis of bulimia nervosa. The present study addresses the question of how patients suffering from bulimia differ from other patients in psychotherapy and from non-clinical control subjects in the way they perceive their ongoing and their past family relationships. The Core Conflictual Relationship Theme method is applied to narrative material from patients belonging to these three groups. Results show expected differences between patients and normal control subjects and virtually no differences between the group of patients with a diagnosis of bulimia nervosa and the group of patients with diagnoses different from bulimia.

Adult↗
PubMed2001

[Course of symptom severity and prediction of outcome in inpatient psychotherapy].

OBJECTIVES: The study looks for typical curves of symptom development in inpatients and investigates the influence of initial remoralisation and terminal improvement on the global therapy outcome. METHODS: 71 psychotherapy inpatients (affective, anxiety, eating and personality disorders; average treatment duration 11.9 weeks) gave weekly self-reports on symptom severity (BSI, Derogatis, 1983) and had a complete outcome evaluation. Regression parameters of the symptom curves were taken for correlational and path analytic calculations. RESULTS: Initial symptom alleviation is able to predict better global outcome. However there is a relevant subgroup of patients which has a good outcome despite an initial deterioration. CONCLUSIONS: Initial remoralisation predicts better outcome but is not a necessary condition. The results partly call into question the group statistical "dose-response-curves". Further studies should test the influence of other process parameters (group cohesion, therapeutic alliance etc.) on the course of treatment.

Adolescent↗
PubMed1999

Measuring psychotherapeutic change with the symptom checklist SCL 90 R.

BACKGROUND: Despite a long tradition of discussions on the evaluation of psychotherapy, there is still a lack of agreement for measuring change after psychological treatment. In this paper we describe the concept of statistical and clinical significance of change. We use the Symptom Checklist 90 R as a commonly administered instrument to propose conventions and cutoff points for psychological symptoms and their change after therapy. METHOD: A German norm population and several psychotherapy samples have been aggregated to calculate cutoffs and confidence intervals (reliable change indices) for statistically and clinically significant changes after psychotherapy. RESULTS: The cutoff point between a 'functional' and a 'dysfunctional' population was calculated as C = 0.57 (Global Severity Index, GSI). Patients above this score need a change of at least RCI = 0.43 (GSI difference) for a statististically significant change. Below this score the RCI = 0.16. The use of multiple clinical groups (e.g. inpatients and outpatients) for a more realistic determination of a 'stepwise' clinically significant change, as proposed by Tingey et al. in the USA, is not possible in the German samples collected so far. Initial SCL 90-R scores in these groups do not show enough differences to call a move from one group to the other a clinically significant change. CONCLUSION: In the German samples investigated the move from a 'functional' to a 'dysfunctional' population and vice versa has to be taken as the criterion for a clinically significant change up to now.

Humans↗
PubMed1998

[The Symptom Checklist-90-R (SCL-90-R) for presenting statistically and clinically significant psychotherapy outcome].

After a long period of discussions on the efficacy of psychotherapy, there is still a lack of conventions for measuring change after psychological treatment. This paper first describes the concept of statistical and clinical significance of change. Using the SCL-90-R as a commonly administered instrument we then propose conventions and cut-off points for its global severity score (GSI) and change after therapy. A German standard population and several psychotherapy samples were aggregated to determine cut-off points and confidence intervals (reliable change indices) for statistically and clinically significant changes. Tingey et al. (1996) proposed the use of multiple clinical groups (inpatients and outpatients) aiming at a more realistic determination of "stepwise" changes. We examined this procedure with our data. Results show that it is not applicable in the German samples collected so far. Initial SCL-90-R scores in these groups did not differentiate sufficiently between inpatients and outpatients. Therefore, according to Jacobson and Truax (1991), moving from a "functional" to a "dysfunctional" population is still the criterion for a clinically significant change.

Adult↗
PubMed1994

A distinct coagulopathy associated with interleukin-2 therapy.

We studied the coagulation profiles of 14 patients with advanced malignancies treated with Interleukin-2 (IL-2). A 43% prolongation of the PTT (P < 0.001) and a significant decrease in functional levels of factors II, IX, X, XI, and XII were observed 6 h post IL-2 treatment in comparison to pretreatment values. These parameters normalized within 2-3 d following IL-2 administration. The PT, factors V, VII, VIII, fibrinogen and D-dimer levels were unchanged with IL-2 treatment. This pattern of coagulopathy has not previously been reported.

Blood Coagulation Disorders↗
PubMed1994

Infusional cyclophosphamide, doxorubicin and etoposide in HIV-related non-Hodgkin's lymphoma: a follow-up report of a highly active regimen.

Based on our prior data suggesting a therapeutic advantage for infusional administration of cyclophosphamide (C), doxorubicin (D), and etoposide (E) in patients with relapsed and resistant non-Hodgkin's lymphoma (NHL), we administered C (750 mg/m2), D (50 mg/m2), and E (240 mg/m2) via continuous intravenous infusion over 96 hours as first line therapy for 21 patients with intermediate- or high-grade non-Hodgkin's lymphoma associated with human immunodeficiency virus (HIV) infection. Treatment was repeated every 28 or more days. The median CD4 count of the study group was 87/ul, and the median serum lactate dehydrogenase was 383 IU/L. Extranodal disease, lymphomatous marrow involvement, and lymphomatous meningitis were present at diagnosis in 90%, 33%, and 10% of patients, respectively. Complete response (CR) occurred in 13 patients (62%, 95% confidence intervals 41%, 81%) and partial response occurred in five patients (24%). The estimated median survival of the study group was 18.0 months. Hematologic toxicity required dose reduction for 47% of cycles and for 79% of patients who received at least two cycles. The mean dose intensity for C, D, and E were 73%, 70%, and 73% of the intended dose intensity, respectively. Opportunistic infection included oral/esophageal candidiasis (N = 7), herpes labialis (N = 3), pulmonary Mycobacterium avium-intracellulare (N = 1), candidemia (N = 1), pneumonitis (N = 1), and disseminated aspergillosis than resulted in a single treatment-related death (5%). Treatment resulted in a significant decrease in the CD4+ lymphocytes, as well as total lymphocytes, T lymphocytes, and CD8+ lymphocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Erythropoietin-augmented isovolemic hemodilution in skull-base surgery. Case report.

Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgical staging was used to manage a red blood cell mass in an anemic Jehovah's Witness patient with a hypervascular meningioma. Erythropoietin (3000 U thrice weekly) and oral iron (1300 mg daily) were given for 1 month prior to surgery, raising the hemoglobin level from 11.8 to 14.1 gm/100 ml. A posterior fossa craniectomy combined with a temporal craniectomy was then performed so that partial petrosectomy, section of the transverse sinus, incision of the tentorium, and exposure of the lesion could be carried out. The first stage of the surgery was terminated immediately prior to tumor mobilization. Isovolemic hemodilution was initiated just before the skin incision. Postoperatively, the hemoglobin concentration dropped to 11.5 gm/100 ml. The erythropoietin dose was doubled and administration of oral iron continued, leading to a hemoglobin level of 14.0 gm/100 ml at 1 month after the first operation. The tumor was embolized using superselective catheterization. The next day, at the second stage of the surgery, the tumor was extirpated, again employing isovolemic hemodilution. By the 4th postoperative day, the hemoglobin level had dropped to 9.4 gm/100 ml. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case. Since erythropoietin has the potential to augment all other forms of autologous banking, its role in elective neurosurgery may become increasingly important in an era of heightened concern about heterologous transfusion.

Blood Transfusion, Autologous↗
PubMed1993

Infusional cyclophosphamide, doxorubicin, and etoposide in human immunodeficiency virus- and human T-cell leukemia virus type I-related non-Hodgkin's lymphoma: a highly active regimen.

Fourteen patients with poor-prognosis intermediate- to high-grade non-Hodgkin's lymphoma (NHL) associated with human immunodeficiency virus (HIV) infection (12 patients) or human T-cell leukemia virus type I (HTLV-I) infection (two patients) received cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and etoposide 240 mg/m2 administered as a continuous intravenous (IV) infusion over 4 days (infusional CDE); treatment was repeated every 28 or more days for up to six cycles. All HIV-positive patients had at least one poor prognostic feature, which included either extranodal disease (10 patients), Karnofsky performance status less than 70% (six patients), a CD4 count less than 100/microL (six patients), or a prior history of acquired immunodeficiency syndrome (AIDS; one patient). Both HTLV-I-positive patients had an elevated serum lactate dehydrogenase (LDH) level, a poor prognostic feature in that setting. Complete response (CR) occurred in 10 patients (71%; 95% confidence interval, 48% to 95%) and partial response (PR) occurred in three patients (21%), yielding an overall objective response rate of approximately 93%. The estimated Kaplan-Meier median survival was 17.4 months; seven of 12 HIV-positive patients are alive and disease-free with a median follow-up of 15 months (range, 7 to 24 months). Hospitalization was required after 19% of treatment cycles due to fever associated with granulocytopenia. Documented or suspected opportunistic infection occurred in five patients (36%), bacteremia occurred in three patients (21%), and candidemia occurred in one patient (7%). There was one treatment-related death attributable to disseminated aspergillosis. This pilot study suggests that infusional CDE may be a highly active regimen capable of producing durable remissions in a high proportion of patients with HIV-related NHL. Further study is required to confirm this observation.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Childhood experiences of loss and suicide attempts: significance in depressive states of major depressed and dysthymic or adjustment disordered patients.

Three hundred and twenty-eight patients aged 45 years and over with major depression, dysthymic disorder or adjustment disorder with depressed mood (according to DSM-III) were asked about childhood loss experiences (death of one or both parents or at least 1 year's separation) and their current state of health. No statistically significant relationships were found between experiences of loss in childhood and type of depression, sex and age at first episode. However, there was an increased incidence of suicide attempts in patients with experiences of loss in childhood, both by separation and by death of parents. The increased suicidal tendency could mainly be attributed to loss of the father.

Adjustment Disorders↗
PubMed1991

Treatment of promyelocytic blast crisis of chronic myelogenous leukemia with all trans-retinoic acid.

Two recent reports have described major clinical benefits from all-trans-retinoic acid (tRA) therapy of patients with promyelocytic leukemia (APL). This paper describes the first patient with a blast crisis of chronic myelogenous leukemia (CML-BC) who responded to oral tRA therapy. In vitro marrow studies, including clonogenic assays, immunopheno-typing, cytogenetics and premature chromosome condensation together with chromosome painting provided evidence for the in vivo differentiation and maturation of the malignant cells. The patient achieved a partial remission with reversal of all clinical features of disease, including normalization of peripheral blood counts, complete resolution of fever, fatigue and splenomegaly, and marked maturation of the bone marrow. This response to tRA in CML-BC is unique, and broadens the spectrum of diseases which may respond to retinoids.

Antineoplastic Agents↗
PubMedDate not supplied

Stereotypical relationship patterns and psychopathology.

BACKGROUND: We explored the relationship between the consistency of relationship patterns and the severity of psychopathology. METHOD: Relationship patterns were assessed by means of Relationship Anecdote Paradigm interviews rated according to the Core Conflictual Relationship Theme (CCRT) method. The repetition of the same type of CCRT components across relationship narratives indicated stereotypical patterns. RESULTS: Subjects treated in an inpatient setting (n = 25) told narratives with more consistent patterns than subjects in an outpatient setting (n = 32). Relationship episodes of normal adults (n = 23) were more flexible compared with the two clinical groups. Especially repetitions of the wish component were closely associated with the severity of psychopathology assessed by SCL-90R. CONCLUSIONS: The consistency of relationship patterns seems to be connected with the severity of psychopathology.

Adaptation, Psychological↗
PubMedDate not supplied

[Effectiveness of a systematic treatment model in an inpatient department of child and adolescent psychiatry].

This is a report on the findings of the effectiveness of the "Viersener Modell", a inpatient systemic child psychiatry model. The therapy effects were recorded, by means of self and therapists assessment, in several relevant areas of change. The index clients (ic) show typical characteristics of a child psychiatry population. The ic (n = 43) and also their parents (37 mothers and 22 fathers) showed significant improvement on the level of psychiatric symptoms, individual problems and in general experience and behavior. The psychiatric symptoms that were conspicuous by both ic and parents at the beginning of therapy, were mainly inconspicuous at the end of the treatment (effectsize (es): icfemale, n = 28 = .82, icmale, n = 15 = .22, motherswithout partner(accompanying) = .20, motherswith partner(accompanying) = .44, fathers = .44). There was no essential improvement in the quality of the couples relationship, on the other hand the relationships were not clinically conspicuous at the beginning of therapy. Family members and therapists assessed quality of the treatment results and process mainly in accordance with our hypothesis. While the therapists noticed a significant improvement in the functioning of the family relationships (es = .87) at the end of the therapy, the parents (reported no difficulties in family functioning at the beginning of therapy) reported no essential improvement of family relationships in the follow-up questionnaire (n = 32). The improvement of the problems and the assessment of the quality of the treatment results remained stable over an eight month period.

Adolescent↗