Bernd Kappis

Determinants of health-related quality of life in patients with persistent somatoform pain disorder

Background. Health‐related quality of life (HRQOL) has been investigated widely in patients with chronic pain, but no study has focused particularly on the situation of patients with persistent somatoform pain disorder.

Childhood Adversities and Suicide Attempts: A Retrospective Study

The aim of the study was to assess the association among various childhood adversities and suicide attempts. A total of 575 patients of a psychosomatic clinic and general practitioners were examined by use of a structured interview. Seventeen percent of the sample reported a suicide attempt in the past. In particular, two forms of early violence (i.e., sexual abuse and harsh physical punishment) were associated with an increased risk for suicide attempts. In addition, financial hardship was associated with an increased risk for suicide attempts. Parental separation or divorce, and physical arguments between parents, increased the risk only in a bivariate analysis; after controlling for other adversities, no association with suicide attempts remained. Suicide attempts can be considered as an act of violence against oneself; they are associated with early experiences of sexual and physical violence.

Was misst der FKV

Zusammenfassung. Theoretischer Hintergrund: Der Fragebogen zur Krankheitsverarbeitung (FKV-LIS; Muthny, 1989) ist ein im deutschsprachigem Raum haufig eingesetzter Fragebogen zur Messung von Krankheitsbewaltigung. Fragestellung: Das Ziel der vorliegenden Studie ist die Uberprufung der Subskalen-Reliabilitat und -Spezifitat bei unterschiedlichen Erkrankungsgruppen. Methode: Die Gutekriterien der FKV-LIS Skalen werden bei Patienten mit chronisch-entzundlichen Darmerkrankungen (n = 1265), Typ-I-Diabetes (n = 552) oder Harnblasenkarzinom (n = 81) berechnet. Konvergente und divergente Trennscharfen der einzelnen Items werden analysiert. Ergebnisse: “Aktive Bewaltigung“ und “Depressive Verarbeitung“ zeigen hinreichende psychometrische Kennwerte, wahrend die weiteren Skalen nicht beibehalten werden konnten. Eine modifizierte FKV-Version mit 15 Items und verbesserter psychometrischer Qualitat wird vorgeschlagen. Schlussfolgerung: Der FKV-LIS bildet zwei wesentliche Bewaltigungsdimensionen bei Patienten mit unters...

Assessing preoperative anxiety using a questionnaire and clinical rating: a prospective observational study.

BACKGROUND Preoperative anxiety and need for information can be detected during preoperative consultation via structured and standardised screening by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire. OBJECTIVE To identify the prevalence of preoperative anxiety and need for information, with regard to influencing factors such as age, sex, previous operation and grade of surgery, and to examine the level of agreement between patients’ self-rating and physicians’ ratings. DESIGN Prospective observational study. SETTING Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany. PATIENTS Two hundred seventeen patients scheduled for elective surgery. INTERVENTIONS The patients completed questionnaires prior to the interaction with the anaesthesiologist. Physicians were blinded to the patients’ ratings and provided their subjective ratings about patients’ anxiety and need for information immediately after seeing the patient. MAIN OUTCOME MEASURE Degree of anxiety and need for information, agreement of patients’ self-reports and physicians rating. RESULTS 18.9% of patients were classified as ’anxiety cases’ (31.8% in women and 10.6% in men). The grade of the intended surgery but no other investigated factor was related to patients’ anxiety. Age (older patients) was correlated with information requirement (r = 0.21, P = 0.002). Analysis of agreement showed only weak correlations between patients’ self-reports and physicians’ ratings, demonstrated in low weighted Kappa-coefficients (0.12 to 0.32). CONCLUSION The APAIS is a useful instrument to assess the level of patients’ preoperative anxiety and the need for information. Given the relationship between preoperative anxiety and postoperative outcome, it seems justified to incorporate this approach into the preoperative consultation. TRIAL REGISTRATION German Clinical Trials Register DRKS00003084.

Parentifizierung in der Kindheit und psychische Störungen im Erwachsenenalter

BACKGROUND Emotional parentification is considered harmful to a childs development. METHOD A total of about 975 patients were examined at a Department of Psychosomatic Medicine and in the practices of general practitioners with regard to childhood adversities. RESULTS Emotional parentification is a risk factor for 2 symptom groups: the patients with depression and the patients with somatoform pain. While the occurrence of depression is mainly predicted by maternal emotional parentification, paternal influences are also relevant in regard to the development of somatoform pain. CONCLUSION Emotional parentification is an important risk factor for the occurrence of psychological and somatoform complaints in adulthood. This is especially apparent in combination with further risk factors, such as low reported values for love, sexual abuse, or being raised without a father.

[Somatoform disorders with pain as the predominant symptom: results to distinguish a common group of diseases].

According to a population-based prevalence study, medically unexplained pain syndromes are highly prevalent in the German general population. With a 1-year prevalence of 8% for somatoform pain disorders and a lifetime prevalence of 12.7%, they rank among the most prevalent conditions in the community. Until now, few studies have been conducted to characterize and differentiate patients with somatoform pain disorders in more detail. The present study is the first to examine a large patient cohort from a university hospital outpatient unit with somatoform disorders presenting with pain as the predominant complaint (n=282). Patients with a nociceptive or neuropathic pain mechanism were excluded after interdisciplinary diagnostic procedures, and all patients were differentiated in terms of comorbid psychic disorders and their symptom presentation. Psychic disorders were assessed using a standardized structured interview (SCID-I and SCID-II) and a structured biographical case history (MSBI) to assess chronification factors. The extent and distribution of bodily symptoms were collected using the screening for somatoform disorders (SOMS). A total of 69% of the patients examined suffered from anxiety and depressive disorders or other mental disorders, and only 14% had a comorbid personality disorder. More than 90% had further bodily symptoms apart from pain. The presence of mental disorders and the duration of the illness were associated with a higher number of bodily symptoms (e.g., fatigue, dizziness), for which they may also consult a doctor. In addition, the frequency of fibromyalgia syndrome increases with the extent of somatization. Our results ultimately support the idea of classifying this group of patients as an independent diagnostic group. They further suggest a future differentiation regarding the degree of impairment within this group similar to the systems of stages used in depressive disorders.

Somatoforme Störungen mit Leitsymptom Schmerz

According to a population-based prevalence study, medically unexplained pain syndromes are highly prevalent in the German general population. With a 1-year prevalence of 8% for somatoform pain disorders and a lifetime prevalence of 12.7%, they rank among the most prevalent conditions in the community. Until now, few studies have been conducted to characterize and differentiate patients with somatoform pain disorders in more detail. The present study is the first to examine a large patient cohort from a university hospital outpatient unit with somatoform disorders presenting with pain as the predominant complaint (n=282). Patients with a nociceptive or neuropathic pain mechanism were excluded after interdisciplinary diagnostic procedures, and all patients were differentiated in terms of comorbid psychic disorders and their symptom presentation. Psychic disorders were assessed using a standardized structured interview (SCID-I and SCID-II) and a structured biographical case history (MSBI) to assess chronification factors. The extent and distribution of bodily symptoms were collected using the screening for somatoform disorders (SOMS). A total of 69% of the patients examined suffered from anxiety and depressive disorders or other mental disorders, and only 14% had a comorbid personality disorder. More than 90% had further bodily symptoms apart from pain. The presence of mental disorders and the duration of the illness were associated with a higher number of bodily symptoms (e.g., fatigue, dizziness), for which they may also consult a doctor. In addition, the frequency of fibromyalgia syndrome increases with the extent of somatization. Our results ultimately support the idea of classifying this group of patients as an independent diagnostic group. They further suggest a future differentiation regarding the degree of impairment within this group similar to the systems of stages used in depressive disorders.

A short screening instrument for mental health problems: The Symptom Checklist-27 (SCL-27) in Poland and Germany

Abstract Objective. The symptom checklist SCL-27 is a short, multidimensional screening instrument for mental health problems. It contains six scales: depressive, dysthymic, vegetative, agoraphobic and sociophobic symptoms; symptoms of mistrust; and a global severity index (GSI-27). Methods. A survey of two student samples from Poland and Germany (n ∼ 400) is presented. Results. Most scales of the SCL-27 showed good to satisfactory reliability (i.e. Cronbachs α > 0.70). Some items displayed different characteristics in students than in non-student samples. These discrepancies can be explained partly by the particular situation students face and partly by some country-specific or language-specific aspects of the measuring instrument. Differences between Polish and German students were marginal at best; in general, the Polish students tended to assent more easily to the items of the SCL-27 than did the German students. Conclusions. The SCL-27 is suitable for international comparisons. In both, Germany and Poland, students display a characteristic response pattern that differs from those of other samples. It can be applied as a separate instrument or for reanalysis of data collected with the SCL-90_R.

Begutachtung bei Posttraumatischer Belastungsstörung mit Leitsymptom Schmerz

Post-traumatic stress disorder (PTSD) is one of the most relevant disorders of patients with chronic pain, but is often underdiagnosed. This also applies to expert testimony. Further complicating the assessment are the different definitions of PTSD in ICD-10 and DSM-IV; the new DSM-5 has added a further definition. The present review aims to provide guidance for making a valid diagnosis. This forms the basis for a differentiated expert testimony in the different fields of law (e.g., criminal law, statutory or private accident insurance or social security benefits), in which different requirements must be taken into consideration by the expert. The recognition of malingering is described at length, which plays a major role in PTSD expert testimony in all fields of law.

Kreuzvalidierung des “Fragebogen zur Messung der psychosozialen Belastungen bei chronisch-entzündlichen Darmerkrankungen (FBCED)“ an einer nationalen Stichprobe

Zusammenfassung. Theoretischer Hintergrund: Der “Fragebogen zur Messung der psychosozialen Belastungen bei chronisch-entzundlichen Darmerkrankungen“ (FBCED) erfasst Alltagsbelastungen bei Patienten mit chronisch-entzundlichen Darmerkrankungen (CED). Fragestellung: Uberprufung der Faktorenstruktur des FBCED. Methode: Faktorenanalytische Kreuzvalidierung an einer Stichprobe von 1322 CED-Patienten. Ergebnisse: Skalenstruktur und psychometrische Kennwerte der FBCED-Skalen (Affektive Verstimmung, Arzt-Patient-Verhaltnis, Angst vor Darmkontrollverlust, Berufliche Beeintrachtigung, Sorge um Krankheitsverschlimmerung, Belastung durch medizinische Masnahmen, Beeintrachtigung der Sexualitat/Partnerschaft, Korperliche Beschwerden) konnten eindeutig repliziert werden. Schlussfolgerung: Der FBCED ist ein reliables Instrument zur Messung krankheitsspezifischer psychosozialer Belastungen bei CED.