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Peter Joraschky

Publications and source records attributed to Peter Joraschky.

17 recordsLinked to original sources
PubMed2006

Human attachment security is mediated by the amygdala: evidence from combined fMRI and psychophysiological measures.

The neural basis of human attachment security remains unexamined. Using event-related functional magnetic resonance imaging (fMRI) and simultaneous recordings of skin conductance levels, we measured neural and autonomic responses in healthy adult individuals during a semantic conceptual priming task measuring human attachment security "by proxy". Performance during a stress but not a neutral prime condition was associated with response in bilateral amygdalae. Furthermore, levels of activity within bilateral amygdalae were highly positively correlated with attachment insecurity and autonomic response during the stress prime condition. We thereby demonstrate a key role of the amygdala in mediating autonomic activity associated with human attachment insecurity.

Adult↗
PubMed2006

[Which kinds of distress do partners or spouses of cardiac arrhythmias patients exhibit?].

OBJECTIVES: Partners or spouses of patients with cardiac arrhythmias were examined for mental and physical health. In addition, gender differences and other influential factors of well-being were analyzed. METHODS: A total of 486 partners or spouses took part in a study which collected data on anxiety and depression (HADS-D) as well as quality of life (SF-12). The situation of the partners was correlated with social variables, psychological distress, and the physical and mental well-being of the patients. RESULTS: Pathological anxiety was reported by 20 percent of the partners and 37 percent demonstrated notable values for depression. In comparison to healthy samples quality of life was diminished, especially in male subjects. There was a strong inter-connection between the patient's psychological strain and that of his or her partner. Most important for the partner's physical quality of life was the patient's quality of life (18.4% explained variance). The partner's mental well-being was determined by his or her own psychological distress (31.1% explained variance). CONCLUSION: Spouses and partners of patients with cardiac arrhythmias are highly impaired in their psychological well-being. This should be taken into account when dealing with medical care issues in such patients. It is therefore important to inform patients and their families in detail about the potential risks as well as the options for relatives' responses in arrhythmia-induced emergencies.

Aged↗
PubMed2005

Do patients with different psychiatric diagnoses require different strategies for certifying sick leave? - first indications from a prospective study.

AIM: To analyze the relationship between duration of prior certified sick leave and the course of symptom severity in a prospective study. METHODS: The severity of psychiatric symptoms was assessed in 109 patients of a psychosomatic/psychotherapeutic polyclinic. Using a basic patient documentation and the Symptom-Check-List SCL-90-R, sociodemographic information, diagnosis, symptom duration, and duration of sick leave were assessed at admission and four to six months later. Intra-individual difference scores were calculated for each patient to assess changes in the severity of psychiatric symptoms. RESULTS: A highly significant interaction between the course of symptom severity, duration of prior sick leave, and diagnostic group was found with two-factorial analysis of variance (F=2.888; P>/=0.01). At the second assessment, patients with anxiety disorders and longer sick leave showed a higher degree of deterioration in symptoms compared with anxiety patients with shorter or no prior sick leave. The patients with depression disorders and long certified sick leave achieved a higher degree of improvement in symptoms compared with depressive patients with shorter or no prior certified sick leave. CONCLUSION: Different diagnostic groups of psychiatric patients require different strategies for certifying sick leave.

Adaptation, Psychological↗
PubMed2004

[Treatment recommendations for outpatients of a psychosomatic hospital: are there relationships with symptom severity and were the recommendations followed?].

Diagnostic psychosomatic outpatient-centers can assist patients in their decision to start psychotherapeutic treatment. Whereas motivating patients to initiate treatment is the most difficult function of the generally one hour lasting sessions. The relationship between symptoms (SCL-90-R/GSI) and recommended type of psychotherapy for outpatients of such a diagnostic outpatient-center was analysed. 4 - 6 months later, symptoms and the type of therapy commenced by these patients were assessed. Significant mean group differences with regard to the type of recommended therapy were detected for each the first and the second assessment as well as between the two assessment points. Individuals recommended an inpatient treatment had the highest mean, followed by crisis-intervention patients, patients with outpatient-recommendation and subjects with "other" recommendations. The GSI-scores were also ascribed to different stages of symptom severity, where distribution differences between the groups could only be determined for the first assessment. For the patients grouped according to the type of therapy they had started, symptomatic differences could not be found for either time of assessment. Whereas 2 % of the crisis intervention patients had started a psychotherapy 4 - 6 months after the first contact, the treatment rate of the patients with recommendation for outpatient treatment was approx. 50 % and with recommendation for an inpatient treatment amounted to less than 20 %.

Adult↗
PubMed2004

The effects of St. John's wort extract and amitriptyline on autonomic responses of blood vessels and sweat glands in healthy volunteers.

St. John's wort extract is widely used and advertised as a "natural antidepressant" lacking autonomic side effects. This randomized, double-blind, placebo-controlled study compared the effects of St. John's wort extract on autonomic responses of blood vessels and sweat glands with those of amitriptyline and placebo. A randomized, double-blind, crossover study was performed in healthy male volunteers aged 22 to 31 years (25 +/- 3 years; mean +/- SD) years. Subjects orally received capsules with 255 to 285 mg St. John's wort extract (900 microg hypericin content), 25 mg amitriptyline, and placebo 3 times daily for periods of 14 days each with at least 14 days between. Vasoconstrictory response of cutaneous blood flow (VR) and skin conductance response (SR) following a single deep inspiration were employed as parameters of autonomic function. St. John's wort extract had no effect on VR and SR. In contrast, SR was diminished and the dilation phase of VR was prolonged following multiple dosing with amitriptyline (P < 0.05). Decreased electrodermal reactivity observed with amitriptyline reflects inhibition of acetylcholine at peripheral m3-cholinoreceptors, whereas prolongation of VR induced by the tricyclic drug may be due to sustained activation of central and/or peripheral sympathetic neurons.

Administration, Oral↗
PubMed2003

[Teaching of psychosomatic medicine and psychotherapy as an element of the Dresden DIPOL-Curriculum -- the PBL-course "Nervous system" and psyche].

A federal law, the "Approbationsordnung für Arzte", regulates Medical education in Germany. In 2002 a revised version of this law demanded of the medical faculties to implement interdisciplinary and problem-based (PBL) courses in their curriculum. Already in 1998 the faculty of medicine of the TU Dresden decided to reform the traditional curriculum. The reform-curriculum is being created in close co-operation with the Harvard Medical School. It is a hybrid curriculum retaining traditional elements as lectures and bedside teaching with PBL-tutorials and a special doctor-patient-communication-training, which is based on role-play exercises. Psychosomatic Medicine is taught together with neurology and psychiatry as a major topic of the 7,5-week PBL-course "Nervous System and Psyche" but there are also lectures and special skills training exercises in other PBL-courses like "Oncology" or "Emergency medicine". Data of the external evaluation showed, that the students accepted psychosomatic topics of the curriculum very well. This paper describes concept, implementation and evaluation data of the PBL-course "Nervous System and Psyche".

Clinical Competence↗
PubMed2003

[Psychosomatic complaints and utilisation of psychosomatic consultation services in gynecology and obstetrics].

The aim of this study was to identify symptoms of depression, anxiety and somatization disorder in gynecological and obstetrical inpatients by screening questionnaires and to compare this findings with utilisation of a psychosomatic consultation service. 517 patients were screened with HADS (anxiety and depression) and GBB-24 (somatic complaints). 28.7% had pathological and, in addition, 19.8% borderline scores in at least one scale. More than 40% had pathological or borderline scores even in a 4-week follow-up and emphasised that they would have preferred having psychosomatic support in hospital. In only 2.9% psychosomatic consultation service was requested. Physicians in the gynecology department rated anxiety depression and the patients' acceptance of psychological factors of their illness significantly lower than the patients themselves. Our results demonstrate that anxiety and depression in gynecological and obstetric patients are not only a momentary phenomenon. Physicians underestimate the need of psychosomatic consultation.

Adult↗
PubMed2003

[The influence of anxiety, depression and post traumatic stress disorder on quality of life after thoracic organ transplantation].

OBJECTIVES: This study examines stress factors, resources of coping, psychopathological symptoms and their influence on health-related quality of life (QoL) in patients after heart or lung transplantation. METHODS: 82 Patients were examined with the questionnaires SF-36 (QoL), HADS-D (anxiety and depression), IES-R and PTSS-10 (post traumatic stress disorder, PTSD) 32.3 (4-86) months after transplantation. Stress factors, resources and diagnostic criteria for PTSD were investigated by structured interview. RESULTS: In the entire sample, anxiety, depression and QoL were in the range of normal population. A subgroup of 13 patients with a PTSD diagnose had significantly reduced QoL. Anxiety and intrusion explained the 42 % variance of psychosocial score of QOL. CONCLUSIONS: There was a lower influence of depression on the medical score of QoL. Psychological symptoms such as anxiety, depression and PTSD significantly influence QoL after heart or lung transplantation. Patients with a PTSD diagnose had poor QoL. Screening for PTSD should be part of routine evaluation after organ transplantation.

Adaptation, Psychological↗
PubMed2002

Effects of olanzapine and clozapine upon pulse rate variability.

Based upon their in vitro receptor binding profiles, the atypical antipsychotics clozapine and olanzapine exhibit cholinergic receptor binding of similar potency. Data comparing the in vivo anticholinergic effects, however, of these neuroleptics upon neurocardiac control are sparse. The goal of this study was to compare the in vivo effects of clozapine and olanzapine upon neurocardiac control by assessment of the pulse rate variability (PRV) in schizophrenic patients and healthy controls. Twenty patients with schizophrenia (according to DSM-III-R criteria) treated with either clozapine (100-600 mg/day) or olanzapine (10-20 mg/day), and ten healthy controls, were recruited into the study. PRV was assessed by continuously recording the skin blood volume in the fingertip of the second digit under resting conditions and PRV parameters were calculated. When significant differences in PRV parameters between the patients and controls were detected by Kruskal-Wallis tests, Mann-Whitney tests were used to test for group differences between the olanzapine- and clozapine-treated patients. In comparison to the healthy controls, the PRV parameters of the clozapine- and olanzapine-treated schizophrenic patients were significantly reduced. Indeed the reduction of PRV was significantly greater in the clozapine-treated group compared to the olanzapine-treated group (P<0.05). Compared to the controls, only the clozapine-treated patients showed a significantly diminished low-frequency (LF)/high frequency (HF)-ratio, a PRV parameter reflecting sympatho-vagal balance. The significantly greater reductions in PRV parameters of the clozapine-treated compared to olanzapine-treated patients may be caused by clozapine's higher affinity for alpha(1)-adrenergic receptors in vivo compared with olanzapine. The similar LF/HF ratios of the healthy controls and olanzapine-treated patients suggests that the sympathetic-parasympathetic modulation of PRV remains relatively unchanged even during olanzapine treatment.

Adult↗
PubMedDate not supplied

[Relationship of sick leave before treatment to severity of symptoms and treatment outcome in in-patients with anxiety disorders].

The aim of this study is to explore whether or not being already on sick leave at admission to a psychosomatic clinic indicates a higher level of severity of symptoms in patients with anxiety disorders, and whether or not this has an impact on therapy outcome. We examined 194 in-patients at 8 psychosomatic clinics upon admission and discharge by interview and psychometric testing. Being on sick leave before admission proved to be an indicator for higher global symptom distress as well as a higher severity of anxiety symptoms. Treatment duration was longer for the sick leave group than for the patients that had not been on sick leave, but each group experienced the same degree of change in pre-and-post treatment symptoms. We conclude that sick leave before admission does give information about illness severity and need of treatment in patients with anxiety disorders.

Adult↗
PubMedDate not supplied

[Consensus paper on the terminological differentiation of various aspect of body experience].

In the past, phenomenological research on subjective body experience was characterised by vaguely defined terminology and methodological shortcomings. The term "body image" has been applied heterogeneously in literature in order to describe a variety of bodily phenomena. In this paper, the German terminology applied to the phenomenology of body experiences is described systematically. In developing a systematic terminology the authors refer to scientific evidence as well as recent reviews, and closely adhere to definitions commonly used in English literature. Different perspectives are utilised, particularly anthropological concepts and theories from developmental and self-psychology. Distinct aspects of body experience are described within the context of a network of external determinants and along a continuum between somatic and mental anchor points. Applying the term "body experience" as umbrella term, different aspects are defined: perceptive (body schema/-perceive), affective (body-cathexis), cognitive-evaluative (body-image, body-ego) and body-consciousness. It is emphasized, that the distinct description of functional levels has to be taken as an approximation of the reality of integrated body experience.

Body Image↗
PubMedDate not supplied

[Psychological existential orientation and health oriented quality of life of inpatients].

The desire and necessity for psychosomatic support were investigated in a gynecological ward of the University of Dresden clinic. Data on anxiety, depression, physical complaints, physical as well as psychological quality of life were collected. The 392 examined women were admitted to the hospital because of gynecological, obstetric or oncological diseases. 39.5 % of the examined patients expressed a desire for psychosomatic support during their stay. Anxiety and depression levels of these patients were higher and the psychological quality of life level lower than for those without the desire for psychosomatic support. Comparing gynecological, obstetric with oncological patients the latter show higher levels of depression and lower psychological quality of life. In contrast the physical quality of life is the lowest for obstetric patients. Our results show that inpatients of a gynecological clinic are physically and psychologically impaired and have a high desire for psychosomatic support.

Adolescent↗
PubMedDate not supplied

[Effects of psychosomatic interventions within the consultation service of a gynecological university hospital].

The influence of psychotherapeutic interventions on the long-term course of anxiety and depression of inpatients of a Gynaecological University Hospital was examined in a prospective naturalistic provision study. All patients admitted to hospital within a year were examined regarding anxiety and depression (HADS). The patients who had conspicuous values in their questionnaires were randomly assigned to an intervention or a control group. There was a follow-up examination for them one year after the first examination. In the first examination 715 participants took part, in the follow-up examination there were 429. Women with malignant gynaecological diseases suffer more severely from anxiety (t=7.02; p<0.001) and depression (t=3.87; p<0.001) in comparison with the normal population. Women suffering from general gynaecological (t=7.75; p<0.001) and obstetrical diseases (t=5.95; p<0.001) are significantly more anxious. Whereas the anxiety in patients with general gynaecological (F=3.02; p=0.031) as well as in patients with obstetrical diseases (F=3.52; p=0.017) can be reduced significantly in the long-term by psychotherapeutic interventions, depression cannot or only slightly be influenced. This shows that low-frequent psychotherapeutic interventions with psycho-educative, supportive approaches (e. g. in the framework of psychosomatic consultation and liaison service) have positive effects on anxiety in the long run, whereas depression is to be influenced rather by long-term interventions or classic depth-psychological or behaviour therapeutic interventions.

Adult↗
PubMedDate not supplied

Mentalizing language development in a longitudinal attachment sample: implications for alexithymia.

BACKGROUND: The construct of alexithymia implies a deficit in symbolization for emotional, somatic, and mental states. However, the etiologic factors for alexithymia have not yet been fully elucidated. The present study investigated the use of mentalizing language, i.e. the utterance of internal states, from a developmental perspective according to attachment organization and disorganization. METHODS: A longitudinal design across 4 time points was applied to a volunteer sample of 42 children. At 12 months, children were tested with the strange situation procedure, the standard measure of attachment at the optimal age, and attachment classifications were taken of videotapes. At ages 17, 23, 30 and 36 months, mother and child were observed in simplified separation episodes of 30 min duration. Transcripts of the sessions were subject to coding of internal state words. RESULTS: During the investigated span, securely attached children rapidly acquired emotion, physiology, cognition and emotion-regulatory language, whereas insecurely attached and disorganized children either completely lacked internal state language or displayed a considerable time lag in the use of emotion and cognition vocabulary. CONCLUSION: The results raise the possibility that alexithymia might be a consequence of deficits in the development of internal state language in the context of insecure or disorganized childhood attachment relationships.

Affective Symptoms↗