Because diet is a key issue in the treatment of diabetes mellitus, it is assumed that these patients are prone to eating disorders. In a multicenter study, we have therefore assessed the prevalence of eating disorders in 662 patients with insulin dependent diabetes mellitus (IDDM) (n = 340) and non-insulin-dependent diabetes mellitus (NIDDM) (n = 322). A two-stage study combining self-rating questionnaires and a standardized interview was carried out. We found a prevalence of eating disorders of 5.9% (lifetime prevalence of 10%), irrespective of gender and type of diabetes; 4.1% of the whole sample reported intentional insulin undertreatment or omission. When patients were stratified according to IDDM and NIDDM, there was no difference in the prevalence of all eating disorders (point prevalence 5.5% vs. 6.5%, lifetime prevalence 10.0% vs. 9.9%). Prevalence of bulimia nervosa (BN) was more frequent in IDDM patients (point prevalence 1.5% vs. 0.3%, lifetime prevalence 3.2% vs. 1.9%) and binge eating (BED) was more frequent in NIDDM patients (point prevalence 1.8% vs. 3.7%, lifetime prevalence 2.6% vs. 5.9%). We conclude that eating disorders seem to be equally frequent in IDDM and NIDDM patients. However, there might be different features of eating disorders in both types of diabetes.

Adolescent↗

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[Comorbidity of diabetes mellitus and eating disorders. A comparison of psychological features of eating disordered and non-eating disordered patients with diabetes mellitus].

As part of a multicentre study on the comorbidity of diabetes mellitus and eating disorders, the following paper compares the psychological features of diabetic patients with and without an eating disorder. In a sample of 663 diabetic patients (type 1: n = 341 type 2: n = 322), eating disorder related variables, self-esteem, body acceptance and emotional distress, especially depression in diabetic patients with and without an eating disorder, were compared. A possible relationship to diabetic control was investigated. Type 2 diabetics revealed more pronounced psychopathology in comparison to type 1 diabetics. According to our assumption, diabetic patients with an eating disorder and diabetic patients who deliberately reduced insulin in order to loose weight (insulin purging) revealed a much more severe psychopathology compared to diabetics without an eating disorder. The type of diabetes was of no importance. With the exception of the variable body and figure satisfaction in the sample of type 1 diabetes and the variable self-acceptance in the sample of type 2 diabetes, no relationship to diabetic control could be found.

Adult↗

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The prevalence and differential diagnosis of subclinical depressive syndromes in inpatients 60 years and older.

BACKGROUND: Depressive syndromes that do not comply with the diagnostic criteria for specific depressive disorders are designated as 'subclinical' or 'subsyndromal' depressive syndromes. Using our own data from a clinical study, this paper outlines the significance of subclinical depressive syndromes and demonstrates the problems of differentiating between depressive and subclinical depression (SD) syndromes and organic mood disorders especially in an elderly population with medical comorbidity. METHODS: Two hundred and sixty-two patients aged 60 years and older in a general hospital were investigated, using a clinical psychiatric interview, expert ratings and self-report scales after extensive internal medical diagnostic evaluation. RESULTS: When, without further differentiation as to their origin, all symptoms required by symptom checklists according to ICD-10 were considered for the diagnosis of major depression (MD), 35.5% of the study participants fulfilled the diagnostic criteria. After differentiating for etiology of symptoms, MD was found in only 14.1%, SD was diagnosed in 17.6% and organic mood disorder in 12.2% of the study participants. In another 41 patients (15.6%), symptoms of depression not fulfilling ICD-10 criteria were classified as being of organic or drug-induced origin. SD patients were in a mean position between nondepressive and depressive patients with regard to social isolation and physical impairment; women were overrepresented in the depressive and subdepressive groups. CONCLUSIONS: SD and organic mood disorder are common and helpful diagnostic categories in the elderly. The results show that in old age there is substantial danger of confounding MD, SD and organic mood disorder, thus leading to erroneously high prevalence rates of MD and underestimations of organic mood disorder if depressive symptoms are recorded only by self-report scales or a symptom checklist. Both internal and psychosomatic-psychotherapeutic competence as well as a liaison service in general hospitals are necessary for the differential diagnosis of MD, SD and organic mood disorder in the elderly with medical comorbidity.

Age Factors↗

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[Inpatient focal therapeutic treatment of elderly patients--concept and initial results].

Acute neurotic and functional symptoms in the elderly are undervalued relative to the frequency. The authors demonstrate the indication criteria and an inpatient focal therapeutic treatment conception for elderly patients. The 11 patients from 50 to 68 years, treated in this setting in 1991, are characterized by sociodemographic aspects, symptoms and length of treatment. At the end of the treatment period (on an average of 8 weeks) seven patients are well recovered with regard to their symptoms, one patient is somewhat improved, and two patients are not recovered. According to a short casuistic some fundamental reflections on psychoanalytic focal therapy in the elderly are discussed.

Aged↗

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[Therapy dropouts in closed groups].

Drop-outs in group psychotherapy are an everyday clinical problem. A premature quitting by one patient may have great consequences, especially in closed groups, not only for the drop-out but also for the remaining group members. Compared to the clinical relevance, empirical research on the conditions leading to a premature termination is quite meagre. Empirical basis of the study presented here are 58 groups with a total of 445 patients with a variety of symptoms and personality structures. All groups started with a 3 month inpatient period and were continued as a closed outpatient group for about 2 years. 110 patients (24.7%) left the group at least 3 months before the agreed end of the group. Empirical research on conditions leading to the premature drop-out is based on three perspectives: 1. patient-oriented: The values of certain patient variables e.g. symptoms, personality structure, socio-economic status etc. are considered as potential predictors. 2. institution-oriented: Here group characteristics are considered as the pool of potential predictors: e.g. group size, decisions made under time pressure, cotherapy etc. 3. group-oriented: The values of patient variables for one patient in relation to other group members (e.g. "isolated position") is considered here. From each perspective we were able to find potential relevant predictors.

Adaptation, Psychological↗

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[Therapeutic factors of inpatient psychotherapy--the patients' view].

Inpatient psychotherapy as a complex treatment program coordinates a multitude of specific, possibly therapeutic helpful components. At least in departments of about 20 or more beds the available therapeutic components are composed or dosed in a different kind for certain groups of patients (indication). In the Psychosomatic Clinic with a ward of 22 beds patients with certain psychoneurotic symptoms, bodily dysfunction or psychosomatic illnesses take part in different inpatient psychotherapy programs for 3 months. This very intensive treatment phase is regularly followed by an outpatient psychoanalytic oriented individual or group-psychotherapy for 1 or more years. For the inpatient treatment phase we differentiate 18 possibly therapeutic helpful factors. Preparing systematic studies we asked the patients at the end of their inpatient treatment phase to judge: to what extent the 18 single factors were helpful. Furthermore a personality questionnaire (Giessen-Test) and a checklist of complaints (Giessen Checklist of Complaints) were routinely filled out by the patients pre and post their inpatient time. From this data we derive independent success-scores which enables us to investigate the association between the subjective assessment of the helpfulness of certain therapeutic factors and somewhat independent criterions. The given data of n = 291 patients allow a empirically based discussion of the question: "What relevance do certain components of inpatient psychotherapy alone or together with other components have for certain groups of patients or specific settings?

Adaptation, Psychological↗

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[Enemy images and so-called goodness].

Explore the source record for details and available documents.

Fantasy↗

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[Study of the practicability of qualitative and quantitative documentation of outcome in inpatient psychotherapy].

The results of a study evaluating the practicability of two newly-developed documentation forms are presented (n = 336 inpatient psychosomatic-psychotherapeutic treatment episodes in 8 clinics). Parallel versions of the forms were completed by patients and therapists. The "ErgeDoku-A-Form" allows for the naming of up to five therapy goals determined at the beginning of therapy and evaluated in relation to their achieved quality at the end of therapy. The "ErgeDoku-B-Form" describes a variety of problem areas as well as questions related to medication and changes in data structure are presented. Results reveal high levels of acceptance in daily clinical practice (indicating clear and appropriate semantics) as well as highly significant relationships between patient and therapist evaluations.

Documentation↗

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[Psychosomatic aspects of pain perception by the elderly--results of the ELDERMEN Study].

115 geriatric in-patients are included in the current study examining relationships between regions of experienced pain, subjective pain intensity, and psychological variables. An investigation of the connection between psychosomatic limitations (BSS) and pain indicated, that pain patients do not necessarily require psychosomatic-psychotherapeutic treatment (in our study only 21.6%). 61.7% of the study sample reported intense pain at least one body region. These patients differed significantly from those with less pain in terms of their level of functional capacity and need for assistance in daily activities (ADL/IADL). They also displayed a significantly more negative attitude towards aging (PGC) than patients with minimal pain. Hierarchical cluster analyses for applied coping strategies produced five groups within the subgroup of patients suffering from extreme pain. Only within one group "depression" was a significant reaction to health-problems. These results make clear that most of the patients with extreme pain are able to cope effectively with pain.

Activities of Daily Living↗

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[Combination of methods and integration of methods as standard in psychotherapy?].

Psychotherapy has undergone a relatively brief but nonetheless dramatic development, but this resulted in an enormous variety, extensive diversity, and good treatment possibilities. Can we say at this stage that the combination and integration of different methods in psychotherapy are today's standards? The authors, a psychoanalyst and a behavioural therapist, consider a greater transparency between the various therapeutic schools as a goal that must still be aimed at before methods can be combined. If such a combination is finally achieved, a standard psychotherapeutic treatment may evolve, since patients suffering from eating disorders, compulsive behaviour or anxiety would profit more from such treatment than from a merely "school"-oriented therapy. Initial ideas for achieving an integration of methods are discussed in respect of inherent limitations and risks.

Behavior Therapy↗