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W Köpp

Publications and source records attributed to W Köpp.

At least 19 recordsLinked to original sources
PubMed2005

[Bulimia nervosa--a modern eating disorder].

Bulimia nervosa is characterized by episodes of compulsive eating of large amounts of food that are followed by measures undertaken to avoid weight gain, and an exaggerated concern about one's figure and weight. Bulimic symptomatology comprises a complex of various interacting components such as poor self-esteem, a negative attitude towards one's own body, eating behavior and current conflicts. Treatment must take account of all of these factors, and involves both internistic and psychotherapeutic elements. The severity of the condition, possible comorbidities, and psychosocial criteria are crucial for deciding whether treatment should be on an ambulatory or an inpatient basis.

Anorexia Nervosa↗
PubMed2005

Predictability of a favorable outcome in anorexia nervosa.

OBJECTIVE: In a long-term follow-up of anorexia nervosa (AN) patients, somatic, psychological and social variables at clinical presentation should be investigated using a multilevel approach. METHODS: This study isolated predictors known from the literature over longer time periods and carried out a separate investigation of predictors in a sample of 81 AN patients of the Heidelberg-Mannheim study over a mean period of 12 years (range 9-19 years). Separate hierarchic regression analyses on the basis of the course of the Morgan-Russell categories were calculated for four individually recorded areas: anamnestic, psychological, somatic and social data sets. RESULTS: Age at the onset of the disease, purging behavior, low serum albumin, high glutamic-oxalo acetic transaminase (GOT) psychopathology (ANSS) and social pathology had the highest predictive value qualities. In survival analysis overall assessment of all six main predictors at clinical presentation could differentiate all patients who recovered from those who remained ill (log-rank test P = 0.019). CONCLUSION: A small number of variables were important for detecting a good or poor long-term course of AN. At onset of the disease, it seems necessary to evaluate these psychological, somatic and social predictors.

Adaptation, Psychological↗
PubMed2003

[Anorexia nervosa].

Explore the source record for details and available documents.

Anorexia Nervosa↗
PubMed2001

[The effects of psychodynamic inpatient treatments on personality data of patients with anorexia nervosa and bulimia nervosa - results of the German multicenter study (TR-EAT)].

OBJECTIVES: How are the effects of a psychodynamic inpatient treatment on personality data of patients with anorexia nervosa and bulimia nervosa? In how many patients can a successful change in the personality area be observed? METHODS: 732 patients were assessed at the beginning and the end of an inpatient treatment as well as 2 1/2 years after this treatment. Data were collected by means of the personality inventories "Freiburger Persoenlichkeitsinventar (FPI-R)" and "Narzissmusinventar". A definition of success was constructed using the clinical significance concept. It is related to the scales life satisfaction, inhibition (FPI-R), powerless self and negative body self (Narzissmusinventar). RESULTS: The results in both questionnaires show the clinically well known psychopathology characteristics of eating disorder patients. During the inpatient treatment and also afterwards, there are improvements in the personality data, but not to the extent of the values obtained from a healthy control group. In the outcome measure, one third of the patients experienced remarkable improvements. The success in the personality area is positively correlated to the success in the eating disorder symptoms. This success could not be predicted by initial data or by therapy data. CONCLUSIONS: There are marked impairments of the patients in the personality data. Changes in this domain take time and are rather small.

Adult↗
PubMed2000

Longitudinal changes of circadian leptin, insulin and cortisol plasma levels and their correlation during refeeding in patients with anorexia nervosa.

OBJECTIVE: To study the longitudinal changes in plasma levels of leptin, insulin and cortisol during the transition from the state of starvation to the state of refeeding focussing on diurnal secretion characteristics and their temporal relationships. DESIGN: Leptin, insulin and cortisol were measured every 2h for 24h during acute starvation (T1). Sampling was repeated after reaching half the target-body mass index (BMI) (T2) and again at target-BMI (17. 5kg/m(2); T3). The temporal relationships between the diurnal secretion patterns were assessed by cross-correlation analysis. RESULTS: Although BMIs at T1 were uniformly low, leptin levels varied widely within a range clearly below normal levels (0.03-1. 7microg/l). With increasing body fat during the course of refeeding, mean leptin levels increased from 0.64microg/l (range: 0.27-1. 73microg/l) (T1) to 1.61microg/l (range: 0.36-4.2microg/l) (T2) and to 3.67microg/l (range: 0.7-9.8microg/l) (T3). Circadian leptin secretion patterns showed maximal values uniformly around 0200h and minimal values around 0800h at all stages of the study. At all three weight levels, plasma leptin levels were highest between midnight and the early morning hours and lowest around the late morning hours. Refeeding neither profoundly changed secretion patterns of leptin nor did it change the positive, time-delayed relationship between leptin and insulin with increments in insulin secretion preceding those of leptin by 6h. A temporal relationship between leptin and cortisol could not be demonstrated in the state of semistarvation but emerged after a substantial weight gain; at that time, leptin increases preceded cortisol increases by 8h. CONCLUSIONS: Absolute leptin, insulin and cortisol levels are profoundly changed during starvation in anorectic patients, while refeeding, paralleled by a BMI gain, reverses these changes. During refeeding the relationship between leptin and cortisol changed profoundly, showing no significant correlation in the state of starvation, whereas at T3 after refeeding a strong inverse relationship could be observed. Leptin and insulin did not correlate significantly at any of the three stages studied.

Adult↗
PubMed1999

[Body weight regulation in anorexia nervosa with special attention to leptin secretion].

Underweight is a key symptom in anorexia nervosa. In this review we summarize recent findings pertaining to weight regulation in this eating disorder. The observation that a body mass index below 13 kg/m2 upon admission for inpatient treatment is associated with a high mortality rate and chronic persistence of underweight is of obvious clinical relevance. A lowered leptin secretion, which results from the weight loss, is presumably of major importance for the development of amenorrhea. We discuss findings pertaining to a reduced body weight in other psychiatric disorders during adolescence in the light of Kretschmer's findings related to body frame and psychopathology.

Animals↗
PubMed1999

Serum leptin levels, body fat deposition, and weight in females with anorexia or bulimia nervosa.

The objective of this retrospective study was to investigate the relation between serum leptin level and fat deposition in patients with eating disorders. 40 female inpatients with anorexia (n=24) or bulimia nervosa (n=16) were assessed for leptin level, body mass index (BMI), and percentage body fat by dual-energy X-ray absorbometry (DXA). The results show that percentage body fat is a better predictor for leptin level and clinical findings in eating disordered patients than BMI. We discuss the necessity for DXA measurements in anorectic patients for prognostic and research purposes.

Absorptiometry, Photon↗
PubMed1998

[Male anorexia nervosa patients in long-term follow-up].

Despite an increasing number of studies on the long-term course of anorexia nervosa, male patients only play a subordinate role in the majority of investigations. Thus, one section of a more comprehensive study aimed at describing possible differences in the disease course of male and female patients. Total assessment after a mean of 12 years revealed a clearly increased mortality rate of more than 20% in 10 of the male patients examined (as well as 2 male anorexia nervosa patients with an additional physical condition). The male survivors had a better prognosis than the females patients. Male anorectics were in better physical condition than their female counterparts at the time of follow-up. On the Morgan Russell scale, food intake, psychosexual and social state showed a more favorable development in male than in female patients. Male patients had a more favorable course regarding psychosocial integration but a similar course as female patients regarding eating disorder symptoms. The results are discussed theoretically and clinically. Further studies with a larger random selection of patients should be carried out.

Adolescent↗
PubMed1998

Serum leptin and body weight in females with anorexia and bulimia nervosa.

In this study we hypothesized that there is a correlation between serum leptin levels and body mass indices within patients with anorexia nervosa or bulimia nervosa during a twelve weeks' course of in-patient treatment. We evaluated leptin levels weekly in female in-patients with anorexia (n = 17) or bulimia nervosa (n = 18). Only patients with anorexia nervosa were therapeutically encouraged to gain weight throughout the treatment episode. For the whole cohort, body mass indices and serum leptin levels were highly correlated upon admission (r = 0.89, p < 0.001). The median intra-individual correlation in the anorexia group was higher than in the bulimia group (0.63 and 0.39, respectively). The intra-individual correlations were higher in those anorexia nervosa patients who showed increments of their body mass index within the observation span. This dynamic aspect is important specifically in patients with anorexia nervosa during therapeutically induced weight gain.

Adolescent↗
PubMed1998

Circadian plasma leptin levels in patients with anorexia nervosa: relation to insulin and cortisol.

In anorexia nervosa, underweight results from a loss of body mass due to a restricted energy intake. Circulating leptin levels have been shown to be low in the acute stage of the disorder. We studied diurnal secretion characteristics of leptin, insulin and cortisol in a study group of anorectic patients prior to refeeding, a second study group of anorectic patients after initiation of refeeding and study groups of healthy underweight and normal-weight controls. Spontaneous secretion of leptin, insulin and cortisol was measured by drawing blood samples every 2 h for 24 h. The temporal relationships between the diurnal secretion patterns of the three hormones were assessed by cross-correlation analysis in every study group. Plasma levels of leptin and cortisol were secreted with a specific circadian rhythmicity and displayed an intricate temporal relationship in anorectic patients. Semistarvation in the non-refed patients was associated with (1) exceedingly low plasma leptin levels, (2) a qualitative alteration in the circadian rhythm of leptin and cortisol levels and (3) an alteration in the temporal coupling between cortisol and leptin. In contrast, in the patients who had gained weight, leptin levels were higher; furthermore, the diurnal pattern of leptin and the temporal relationship between leptin and cortisol were similar to controls. Increments in insulin secretion preceded those of leptin by 4-6 h in both anorectic patients and in controls. Leptin levels increased 4 h prior to those of cortisol in controls and in refed patients, whereas in the non-refed patients cortisol increased prior to leptin. Thus, anorexia nervosa leads to pronounced, albeit reversible changes in the secretion dynamics of leptin and cortisol.

Adult↗
PubMed1997

Low leptin levels predict amenorrhea in underweight and eating disordered females.

Evidence that leptin plays an important role in reproductive function is accumulating rapidly. We hypothesized that low leptin synthesis is associated with amenorrhea. We therefore determined serum leptin levels in 43 underweight female students, who were screened for lifetime occurrence of amenorrhea. We assessed the predictive value of leptin, body mass index (BMI), fat mass and percent body fat, respectively, for lifetime occurrence of amenorrea. Factors predicting amenorrhea were tested for their capability to predict current amenorrhea in a second cohort of 63 inpatients with anorexia nervosa (AN) or bulimia nervosa (BN). Furthermore, the relationships between serum leptin levels and of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone, respectively, were evaluated. Only leptin predicted lifetime occurrence of amenorrhea in the student cohort. The critical leptin level was in the range of 1.85 micrograms L-1. This level served to largely separate anorectic from bulimic patients. In patients with AN mean serum log10 leptin levels over the first 4 weeks of inpatient treatment were correlated with mean FSH, LH and estradiol levels, respectively. Evidently, a critical leptin level is needed to maintain menstruation. In affluent populations eating disorders are likely to be a major cause of a low leptin synthesis.

Adolescent↗
PubMed1996

[Comments on the importance of training analysis for practical psychotherapy work].

The discussion about how training analyses should be performed has lasted now over 70 years. This paper summarizes only briefly the history of this discussion but focusses on the role of the so-called training analysis for the practical psychotherapeutic work. It is emphasized that psychoanalytical self experience and an effective supervision guarantee best a good quality of the patient's treatment. However, the common "training analysis" of the psychoanalytical institutes is criticized by the authors and the idea of a "normal" analysis is preferred instead.

Countertransference↗
PubMed1994

[The incidence of sexual abuse in women with eating disorders].

The literature is contradictory concerning a possible connection between sexual abuse and the development of eating disorders. In the present study, the medical records and psychotherapeutic courses of all female patients (n = 127) were reviewed for the years 1987-1989 in the Department of Psychosomatics and Psychotherapy at Steglitz Medical Center in Berlin in order to record any reported incidences of pre-onset sexual abuse as well as the age at the time of abuse. The women were subdivided into four diagnostic groups: obesity (n = 14), bulimia (n = 18), anorexia (n = 22) and others without eating disorders (n = 73). Altogether, sexual abuse was reported in 19% with and 10% without eating disorders (difference not statistically significant). Comparison of the individual diagnostic groups unexpectedly revealed a significantly higher frequency of sexual abuse among obese patients than among those without eating disorders (36% vs. 10%, p = 0.028).

Adolescent↗
PubMed1993

[Foreign patients in psychosomatic ambulatory care].

To investigate differences between the complaints of foreign and of German patients who presented at our psychosomatic outpatient department, we documented relevant social data and the results of all diagnostic interviews conducted in 1990. Of the 608 patients (100%), 542 (89.1%) were German and 66 (10.9%) of other nationalities. Foreign patients more often lived in families and more often were unemployed. They reported a higher rate of functional disturbances with a marked difference between males and females. Mental symptoms were significant rarer in foreign males. Psychoanalytic or psychodynamic treatment was more frequently recommended to German patients. Especially females of other nationalities were frequently recommended outpatient psychiatric treatment (24%) or given no treatment recommendation at all (22%). In the last section, treatment recommendations and prognostic evaluations will be discussed, taking into account the possibility of cultural subjectivity on the part of the advisers.

Adult↗
PubMed1992

Psychosomatic evaluation of patients with congenital penile deviation. A postoperative catamnestic follow-up.

Thirty-three patients with congenital penile deviation were examined by a semi-structured interview and psychodiagnostic tests (Giessen test, Giessen complaint sheet) prior to undergoing surgery according to the Nesbit-Kelâmi technique. A prognosis was then made to determine the extent to which the problems and disturbances reported by the patient or uncovered by the examiner could be improved by the operation. This prognostic assessment was then verified in a subsequent catamnestic examination (N = 20), at an average of 21.3 months after the intervention. An attempt is made to identify and define preoperative indicators that permit to predict the postoperative course.

Adolescent↗