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Biomedical subjects

W Eich

Publications and source records attributed to W Eich.

18 recordsLinked to original sources
PubMed2005

[Stress and autonomic dysregulation in patients with fibromyalgia syndrome].

AIM: The aim of the present study was to evaluate to what extent the orthostatic dysregulation of FMS patients can be attributed primarily to reduced baroreceptor-mediated activation of the sympathetic nervous system and whether a hyporeactive sympathetic nervous system can also be confirmed for mental stress. PATIENTS AND METHODS: A total of 28 patients with primary FMS were examined and compared with 15 healthy subjects. Diagnostic investigations of the autonomic nervous system were based on measuring HRV in frequency range and assessing spontaneous baroreflex sensitivity (sBRS) under mental stress and passive orthostatism. RESULTS: Both under orthostatic and mental stress FMS patients exhibited reduced activation of the sympathetic nervous system as measured by the spectral power of HRV in the low-frequency range and the mean arterial blood pressure or heart rate. The present study provided no indications for dysregulation of sBRS. CONCLUSION: The results obtained confirm the hypothesis of a hyporeactive stress system in FMS patients for both peripherally and centrally mediated stimulation of the sympathetic nervous system.

Adult↗
PubMed2005

Using interaction graphs for analysing the therapy process.

BACKGROUND: Therapy processes are complex dynamical systems where several variables are constantly interacting with each other. In general, the underlying mechanisms are difficult to assess. Our approach is to identify the dependency structure of relevant variables within the therapy process using interaction graphs. These are instruments for multivariate time series which are based on the analysis of partial spectral coherences. We used interaction graphs in order to investigate the therapy process of a multimodal therapy concept for fibromyalgia patients. Our main hypothesis was that self-efficacy plays a central role in the therapy process. METHODS: Patients kept an electronic diary for 13 weeks. Pain intensity, depression, sleep quality, anxiety and self-efficacy were assessed via visual analogue scales. The resulting multivariate time series were aggregated over individuals, and partial spectral coherences between each pair of the variables were calculated. From the partial coherences, interaction graphs were plotted. RESULTS: Within the resulting graphical model, self-efficacy was strongly related to pain intensity, depression and sleep quality. All other relations were substantially weaker. There was no direct relationship between pain intensity and sleep quality. CONCLUSIONS: The relations between two variables within the therapy process are mainly induced by self-efficacy. Interaction graphs can be used to pool time series data of several patients and thus to assess the common underlying dependency structure of a group of patients. The graphical representation is easily comprehensible and allows to distinguish between direct and indirect relationships.

Adult↗
PubMed2004

[Development and validation of assessment instruments for shared decision making].

The German Ministry for Health and Social Security is funding ten projects to introduce shared decision making into clinical practice. The medical problems the projects are focussing on were chosen from among various diseases (e. g. depression, multiple sclerosis, cancer). The ten projects achieved consensus on a core set of instruments for the measurement of process and outcome of the shared decision making. Instruments developed in German-speaking countries are currently not available. Thus, linguistic and cultural validation had to be performed for the core set instruments. The results of the data analysis as well as patient interviews demonstrate the need for improving these instruments. Therefore, the members of the methodological working group concentrated on the integration of these results in a new instrument. In a first step the construct of "shared decision making" was defined, followed by a definition of the process elements characterising shared decision making. Thereafter, items were developed on the basis of the process elements. The new instrument will now be validated for different diseases.

Decision Making↗
PubMed2004

[Shared decision making (SDM) with chronic pain patients. The patient as a partner in the medical decision making process].

Fibromyalgia syndrome (FMS) is an exemplary condition of chronic widespread pain that is difficult to control and often leads to frustration and resignation on the part of both the patient and the doctor. Shared decision making (SDM) could be a means to facilitate doctor-patient interaction and might therefore influence therapeutic decisions taken. We conducted a prospective study to evaluate the effects of SDM with FMS patients. We developed a communication train-ing program for physicians and a computer-based information tool on FMS for patients. The study included 133 FMS patients. Intervention group I (IG I) was treated by communication-trained doctors and had access to a computer-based information tool on FMS,intervention group II (IG II) was treated by standard doctors and received the information tool, and the control group (CG) was treated by standard doctors and got no additional information. All three groups we-re offered the same evidence-based treatment options for FMS. Patients of the IGs were more willing to become involved in exercise, to enroll in integrated group therapy for FMS patients (IGTF), and to take analgesics. Patients of the CG preferred anti-depressants. More patients from IG II and CG opted for relaxation techniques. Patients in IG I and IG II choose significantly more therapeutic options than patients in the CG. SDM is one means to increase FMS patients' readiness for treatment. Especially the element of providing sufficient medical information seems to account for this effect. The readiness to enroll in physical activities, to take analgesics, and to participate in psychotherapeutic elements was most likely to be raised through SDM.

Adult↗
PubMed2004

[Psychosomatics in rheumatology].

Psychosocial factors influence the course and the outcome of chronic somatic diseases. This is also valid for rheumatic diseases like rheumatoid arthritis, spondyloarthropathies, systemic collagen vascular diseases, and fibromyalgia syndrome. The article summarises the evidence-based findings and it illustrates possibilities of psychosomatic treatment in rheumatic diseases by means of three case reports.

Adult↗
PubMed2003

[Psychosocial factors in a fibromyalgia syndrome patient. Assessment by means of electron pain diaries--casuistics and multivariate time series analysis].

OBJECTIVE: Fibromyalgia syndrome (FMS) is a condition of chronic widespread pain. In its process of chronification psychosocial factors play an important role. A multimodal treatment including integrated group therapy has been proved to be effective. Yet little attention has been paid so far to the exact sequence of changes and interrelation between psychosocial factors, functional capacity, and level of pain under integrated group therapy for FMS patients. METHODS: One FMS patient was exemplarily monitored with an electronic diary over 13 weeks while undergoing integrated group therapy. On a daily basis we assessed the level of pain, functional capacity, and other disease-related variables (anxiety, depression, quality of sleep, self-efficacy) via visual analog scales. By the means of multivariate time series analysis the timing of changes in psychosocial factors and their effects on perceived functional capacity was identified. RESULTS: Under integrated group therapy all assessed variables gradually changed in the predicted way. Pain, depression, anxiety could be reduced, whereas self-efficacy, quality of sleep, and functional capacity improved. 71% of the variance could be explained by the multiple regression model. Self-efficacy was, beside pain intensity and depression, an important predictor for functional capacity on the same day. High self-efficacy correlated negatively with the level of functional capacity 3 days later. CONCLUSION: Integrated group therapy proved to be effective. Self-efficacy played an important role regarding the improvement of functional capacity. Depicting the exact timing of changes in the assessed variables helped to detect patterns of influence and indicate directions for further treatment.

Electronics↗
PubMed2003

[Psychosomatic aspects in the diagnosis and treatment of fibromyalgia].

The fibromyalgia syndrome (FMS) is a chronic pain condition of the musculoskeletal system defined by criteria of the American College of Rheumatology in 1990. Despite this definition, etiology and pathogenesis of FMS are still unknown, and consequently the therapy aims mainly at relieving symptoms. The favourite hypothesis is a multietiological concept including genetic, central nervous, muscular, and psychological issues. This article focuses on current psychological aspects as to etiology, process of chronification, and therapy of FMS. Regarding etiology there are diverging hypotheses rather than a general agreement, e.g. specific personality traits, traumatic events, psychodynamic explanations on the basis of a depressive conflict, or the subsumption under somatoform disorders. However, psychological aspects are evident to influence the course and treatment of FMS. In the chronification process behavioural aspects like avoidance behaviour with subsequent physical impairment, attitudes towards subjective theories of illness and therapeutic options, social factors like effects on work, interpersonal conditioning, and coping strategies play an important role. Therapeutic options of FMS comprise exercise, drugs, and psychotherapy. An integrated approach combining these options, a sustainable doctor-patient relationship, and a continuous support of the patient seem to be beneficial.

Depression↗
PubMed2001

[A differentiated study of the retinal function in segmental retinitis pigmentosa by multifocal electroretinograms].

PURPOSE: Generalized retinal degenerations such as retinitis pigmentosa may manifest with focal retinal dysfunctions. These may be detected objectively by new electrophysiological techniques, such as multifocal electroretinography (ERG). CASE REPORT: A mother and daughter, aged 81 and 46 years, showed bilateral caudal bone spiculae formations with corresponding cranial visual field defects in the static perimetry of the central visual field (Octopus) and in the kinetic perimetry (Goldmann). RESULTS: Pattern VEP, pattern ERG, EOG, and cone ERG were within the normal range. The scotopic ERG was in the lower normal range. The multifocal cone ERG of the central 50 degrees showed reduced amplitudes and prolonged latencies in the first-order response component. These findings corresponded to the area of the bone spiculae and the scotomata. CONCLUSION: Multifocal ERG enables the detection of focal retinal cone dysfunction in segmental retinitis pigmentosa. It is an additional tool that may aid in the diagnosis and classification of this disease.

Age Factors↗
PubMed2001

Antibodies against serotonin have no diagnostic relevance in patients with fibromyalgia syndrome.

OBJECTIVE: To determine the prevalence and potential diagnostic relevance of autoantibodies against serotonin, thromboplastin, and ganglioside Gm1 in patients with fibromyalgia syndrome (FM). METHODS: Sera from 203 patients with FM and 64 pain-free control subjects were analyzed with enzyme immunoassays. Clinical and psychometric data of the patients were analyzed for the presence or absence of autoantibodies. RESULTS: Compared with control subjects patients with FM had a significantly higher prevalence of autoantibodies against serotonin (20% vs 5%; p = 0.003) and thromboplastin (43% vs 9%; p < 0.001), but not against ganglioside Gm1 (15% vs 9%; p = 0.301). Differences in autoantibody prevalence between controls and FM patients were not related to age or sex. No association was found between autoantibody pattern and clinical or psychometric data, e.g., pain, depression, pain related anxiety, and activities of daily living. CONCLUSION: There is an elevated prevalence of antibodies against serotonin and thromboplastin in patients with FM. The pathophysiological significance of this finding is unknown. Calculation of positive predictive values of antiserotonin antibodies shows that measurement of these antibodies has no diagnostic relevance.

Adult↗
PubMed2000

[Health care utilization in patients with Fibromyalgia Syndrome (FMS)].

BACKGROUND: The purpose of the study was to examine the pain related health care utilization in patients with fibromyalgia syndrome. METHODS: In a multicenter study six rheumatological hospitals associated in the rheumatological center of Heidelberg participated. All consecutive patients which fulfilled the ACR-criteria of fibromyalgia were assessed. Data about pain and related treatments were available from n=259 patients. RESULTS: Patients suffered from chronic generalized pain on average for 5 years before being diagnosed as fibromyalgia. In most of the cases longlasting localized pain symptoms preceeded generalized pain. The spectrum of pain related treatments seems to be wide and arbitrary: 87% took questionable or excessive medication. 86% had some form of physiotherapy and 41% already experienced psychological treatment. 28% of the patients consulted dental surgeons including teeth extraction and 20% underwent multiple orthopaedic surgery. A mean of five different health care professionals were consulted regarding the pain problem. Treatment satisfaction rated by the patients was lowest with pharmacological and highest with psychological treatment and physiotherapy. CONCLUSIONS: The health care-seeking behavior of fibromyalgia-patients seems to be characterized by a multitude of different treatment attempts. Treatment was often invasive and focused on localized symptoms rather than on the generalized pain syndrome. An early confirmation of the diagnosis and a more evidence based treatment is strongly indicated.

English Abstract↗
PubMed2000

The role of psychosocial factors in fibromyalgia syndrome.

OBJECTIVE: The main objective of this review was to evaluate the role of psychosocial factors in the development of fibromyalgia syndrome. METHOD: Review of the literature concerning the influence of psychosocial factors. RESULTS: In fibromyalgia syndrome psychosocial factors are relevant at different etiological levels. They can be classified into predisposing, triggering and stabilising/"chronifying" factors. CONCLUSION: Due to the increasing knowledge about the influence of psychosocial factors for the development of fibromyalgia, the biomedical model has to be expanded to a biopsychosocial model. The biopsychosocial concept has an impact on the therapeutic approach. Strong evidence for the model is provided by the good results of interdisciplinary treatment studies.

Disease Susceptibility↗
PubMed1999

[Differential diagnosis in anorexia nervosa: glycogenosis II (the Pompe type)].

HISTORY AND ADMISSION FINDINGS: A 29-year-old woman had since early childhood been smaller and thinner than her contemporaries. Her weight was now 36.5 kg, height 158 cm. Anorexia nervosa being suspected she was to be admitted to a psychosomatic clinic. A few days before the date she developed respiratory failure which required mechanical ventilation for a month. Physical examination revealed markedly reduced musculature. INVESTIGATIONS: Muscle biopsy and fibroblast culture indicated acid maltase deficiency (glycogen storage disease Type II [Pompe's disease]). Lung functions were markedly reduced, blood gas analysis revealing global respiratory insufficiency. TREATMENT AND COURSE: Intermittent patient-controlled ventilation (at night by intermittent positive pressure ventilation) clearly improved both her general condition and blood gases. CONCLUSIONS: Acid maltase deficiency should be included as a possible cause of the differential diagnosis of anorexia nervosa. This diagnosis should strictly follow the criteria listed in ICD-10 (International Classification of Diseases), but also after exclusion of other causes.

Adult↗
PubMed1998

A possible role for saliva as a diagnostic fluid in patients with chronic pain.

OBJECTIVES: The focus of this review was on proteins and peptides found in saliva. Of greatest interest were those neuropeptides relevant to nociception and to the pathogenesis of chronic pain syndromes. An additional goal was to develop a standardized protocol to collect saliva for laboratory assessment. METHODS: Data were obtained through discussion with experts at the medical schools in San Antonio and Heidelberg and a Medline literature search involving all relevant studies from 1966 to 1997. The literature search was based on the following key terms: saliva, serotonin, neuropeptide, substance P (SP), calcitonin gene-related peptide (CGRP), and nerve growth factor (NGF). RESULTS: The mean concentration of SP in the saliva of healthy normal controls ranged from 9.6 to 220 pg/mL. Generally, the concentration of SP was approximately three times higher in saliva than in plasma. In a number of painful conditions, particularly tension headache, substantial elevations of salivary SP were found. Mean values for salivary CGRP in healthy controls were approximately 22 pmol/L and were significantly elevated in patients with migraine attacks or cluster headache. There were no data to indicate prior quantitative determination of NGF in human saliva. CONCLUSIONS: After sampling and processing techniques have been standardized, measurement of neuropeptides in human saliva could provide a valuable tool for study of patients with chronic painful disorders such as rheumatoid arthritis, osteoarthritis, and even fibromyalgia syndrome.

Animals↗
PubMed1997

[Psychosomatic treatment of backache].

The prevalence of back pain is increasing. Usually, back pain is associated with additional vegetative, functional, and mental disorders. Mental factors may contribute to the maintenance of pain and to chronification. The degree of the back pain has a wide variety. According to an international consensus, it is tried to take the view of back pain as a biopsychosocial model. The accordingly derived psychosomatic treatment procedures need a differential indication. Beside the basic psychosomatic treatment, the individual therapy by qualified psycho-therapists and the behaviour therapeutic and depth psychological oriented group therapy by specifically trained physicians belongs to the psychosomatic procedures.

Behavior Therapy↗
PubMedDate not supplied

[Expanded anamnesis and psychodiagnostic classification in psychosomatic rheumatic patients. II: A recommendation for diagnostic classification of psychosomatic disorders of the locomotor system].

This paper tries to associate psychosomatic manifestations of the locomotion-system to one of the following four diagnosis: 1) conversion disorder, 2) anxiety disorder, 3) depressive mood disorder, 4) somatization disorder. For each of these diagnosis definition, clinical manifestation, diagnostic and differential-diagnostic criteria are mentioned. The diagnostic criteria can easily be associated to the new ICD-10 (V)F diagnosis.

Aged↗