Elisabeth Ponocny-Seliger

Utilization of psychotherapy in patients with personality disorder: The impact of gender, character traits, affect regulation, and quality of object-relations

OBJECTIVES The aim of the study was to generate hypotheses for examining gender differences in variables with predictive value for the utilization of psychotherapy in patients with personality disorders (PDs). DESIGN Personality traits, affect experience and regulation, the quality of object relations and interpersonal problems within the process of psychotherapy planning were assessed in 140 psychiatric outpatients. METHODS Besides the structured clinical interviews for DSM-IV I+II, variables were assessed with the Shedler-Westen assessment procedure (SWAP-200), the affect regulation and experience Q sort (AREQ), the quality of object-relations scale (QORS), and the Inventory of Interpersonal Problems (IIP). Correlation and group difference statistics, regression and canonical correlation analysis were performed. RESULTS Predictors concerning the utilization or non-utilization of psychotherapy were a schizoid PD rating a self-report of subassertive behaviour related to interpersonal problems in women, and a narcissistic PD rating in men. Canonical correlations between predictors and quality of object relations or interpersonal problems were found in women, while in men there was merely a tendency for predictor and affect regulation to be related. CONCLUSION The results suggest that for men it is more important to interpret the dominating affect, while for women, understanding the pathological object relation pattern is useful for successful therapy planning.

Psychological Reactions in Women Undergoing Fetal Magnetic Resonance Imaging

OBJECTIVE: To investigate womens psychological reactions when undergoing fetal magnetic resonance imaging (MRI), and to estimate whether certain groups, based on clinical and sociodemographic variables, differ in their subjective experiences with fetal MRI and in their anxiety levels related to the scanning procedure. METHODS: This study is a prospective cohort investigation of 62 women before and immediately after fetal MRI. Anxiety levels and subjective experiences were measured by questionnaires. Groups based on clinical and sociodemographic variables were compared with regard to anxiety levels and to the scores on the Prescan and Postscan Imaging Distress Questionnaire. RESULTS: Anxiety scores before fetal MRI were 8.8 points higher than those of the female, nonclinical, norm population (P<.001). The severity of the referral diagnosis showed a linearly increasing effect on anxiety level before MRI (weighted linear term: F1,59=5.325, P=.025). Magnetic resonance imaging was experienced as unpleasant by 33.9% (95% confidence interval [CI] 21.2–46.6%) and as hardly bearable by 4.8% (95% CI 0–17.5%) of the women. Physical restraint (49.9%, 95% CI 37.4–62.4%), noise level (53.2%, 95% CI 40.7–65.7%), anxiety for the infant (53.2%, 95% CI 40.7–65.7%), and the duration of the examination (51.6%, 95% CI 39.1–64.1%) were major distressing factors. CONCLUSION: Women who undergo fetal magnetic resonance imaging experience considerable distress, especially those with poor fetal prognoses. Ongoing technical developments, such as a reduction of noise, shortening the duration of the MRI, and a more comfortable position in open MRI machines, may have the potential to improve the subjective experiences of women during fetal MRI. LEVEL OF EVIDENCE: III

Validation of the SWAP-200 for diagnosing psychostructural organization in personality disorders

Background: The aim of the study was to investigate the validity of the prototype-matching, empirically based 200-item Shedler-Westen Assessment Procedure (SWAP-200) and its clinical utility for describing underlying dimensions of psychostructural organization and functioning. Sampling and Methods: Patients (n = 306) from two psychoanalytic out-patient departments were included. Replicatory and exploratory factor analysis, correlation and discriminant validity statistics, and canonical correlation analysis were performed. Results: Replicatory factor analysis failed to reproduce the identical original factorial structure. Standard factor analysis revealed an eight-factor solution displaying a dimensional description of psychostructural personality organization (high functioning – neurotic/inhibited – borderline/emotionally dysregulated – psychotic/dissocial). Discriminant validity exists across the sample owing to high/poor psychological functioning. Canonical correlation analysis does not support the replacement of the Structured Clinical Interview for DSM-IV, but provides relevant implications for refining DSM-IV axis II. Conclusions: Support is given for the SWAP instrument in describing dimensional higher-order personality organization and psychostructural functioning.

Economic growth and the incidence of occupational injuries in Austria

ZusammenfassungZIEL: Das Ziel der vorliegenden Studie bestand darin, den möglichen Einfluss des Wirtschaftswachstums gemessen durch das Bruttoinlandsprodukt auf die Inzidenz von Arbeitsunfällen in Österreich zu untersuchen. METHODIK: Die Beziehung zwischen dem Bruttoinlandsprodukt und Arbeitsunfällen von österreichischen Angestellten wurde zwischen den Jahren 1955 und 2004 mittels eines Fehlerkorrekturmodells analysiert. Im Jahr 1955 bestand die Stichprobe aus 1,568.371 Personen. 2004 umfasste sie 2,656.952 Personen. Die Arbeitsunfälle wurden in Unfälle mit tödlichem und mit nichttödlichem Ausgang unterteilt. RESULTATE: Zwischen 1955 und 2004 sank die Gesamtunfallrate von 8,59% auf 4,08%. Unfälle mit tödlichem Ausgang sanken von 0,03% auf 0,01%. Die Rate der Unfälle ohne tödlichem Ausgang halbierte sich von 8,56% auf 4,07%. Das österreichische Bruttoinlandsprodukt stieg von 37,7 Milliarden Euro auf 202,8 Milliarden Euro (Basis 1995). Die statistische Analyse zeigte, dass steigender Wohlstand deutlich mit sinkenden Arbeitsunfallraten (tödlich und nicht tödlich) assoziiert ist. Dieser Zusammenhang lässt sich einerseits dadurch erklären, dass in Zeiten der Rezession weniger Investitionen in neue und sichere Technologien sowie in den betriebsinternen Arbeitnehmerschutz investiert wird. Andererseits erhöht die Angst vor Arbeitslosigkeit, die in Rezessionsphasen deutlicher ausgeprägt ist, das Unfallrisiko. SCHLUSSFOLGERUNGEN: Die ökonomische Entwicklung hat Auswirkungen auf die Inzidenz von Arbeitsunfällen. Gerade während Phasen des verlangsamten Wirtschaftswachstums und in Phasen der Rezession sollten die Maßnahmen zur Steigerung der Arbeitssicherheit und zur Unfallprävention verstärkt werden.SummaryOBJECTIVES: The aim of this paper was to analyze the impact of economic growth measured by real gross domestic product (GDP) on the incidence of occupational injuries in Austria. METHODS: The relationship between GDP and the occupational injury rate of the wage-earning population between 1955 and 2004 was analyzed using an error correction model. The sample size increased from 1.568,371 persons in 1955 to 2.656,952 in 2004. Occupational injuries were divided into fatal and non-fatal injuries. RESULTS: Occupational injuries (fatal and non-fatal) decreased from 8.59% to 4.08%: non-fatal injuries decreased from 8.56% to 4.07%; fatal injuries decreased from 0.03% to 0.01%. Austrian GDP increased from EUR 37.7 billion to EUR 202.8 billion (base year 1995). Statistical analysis clearly shows that a growing economy is associated with declining injury rates (fatal and non-fatal). Two mechanisms are discussed. Firstly, rising GDP is accompanied by greater investment in safer technologies and occupational safety measures. Secondly, booming economies are associated with a reduced risk of unemployment, which is already known to be a risk factor for occupational injuries. CONCLUSIONS: Economic development appears to have an impact on the incidence of occupational injuries in Austria. Health policy should emphasize the necessity for safety at work particularly in phases of economic slowdown.

Gender aspects in the planning of psychotherapy for borderline personality disorder

ZusammenfassungUntersuchungsziel war die Erfassung geschlechtsspezifischer Variablen für eine erfolgreiche Psychotherapieplanung und die Untersuchung von Gender-relevanten Einflussfaktoren auf den stationären Behandlungsverlauf bei Patienten mit Borderline-Persönlichkeitsstörung. An zwanzig Patienten wurden Angst, aggressive Verhaltensweisen, interpersonelle Probleme, Kontrollüberzeugungen und Selbstkonzept vor und nach 6-wöchiger psychoanalytisch orientierter stationär psychiatrischer Behandlung untersucht. Bei Frauen bestand soweit Einsicht in Zusammenhänge zwischen Angst, Aggression, Affizierbarkeit und interpersonelle Probleme, dass diese Problematik Ich-synton ihren Niederschlag im Selbstbild fand, dementsprechend reflektiert und in vor allem gleichgeschlechtlichen Patient-Therapeut-Dyaden weitergehend bearbeitet werden konnte, sodass eine ambulante Psychotherapie weiterführend in Anspruch genommen werden konnte. Männer verharrten stärker in regressiver Abwehrhaltung und in narzisstischer Betonung starker Selbstwirksamkeitsüberzeugungen, gleichzeitig persistierte die Aggression, und eine Ablehnung von weiterführender Psychotherapie herrschte vor. Die Ergebnisse legen eine geschlechtsadäquate Bearbeitung der Aggressionproblematik, Bindungs- und Reflexionsfähigkeit nahe und werden anhand psychoanalytischer Hypothesen diskutiert.SummaryOBJECTIVE: The aim of the study was to generate hypotheses for examining gender-specific variables with predictive value for the planning of successful psychotherapy in patients with borderline personality disorder. METHODS: Anxiety, aggression, interpersonal problems, locus of control and self-concept were investigated in twenty psychiatric inpatients before and after psychoanalytically oriented psychotherapy lasting for six weeks. RESULTS: Women in gender-matched patient-therapist dyads gained insight into relationships between anxiety, aggression and interpersonal problems to the extent that they experienced them as ego-syntonic problems and as a concern of their own self-concept, and were therefore able to engage in further outpatient psychotherapy. Men more often remained in regressive resistance and in narcissistically boosted conviction of self-efficacy, with simultaneous persistence of aggression and non-engagement in further psychotherapy. CONCLUSION: The results underline the importance of considering gender role stereotypes and suggest the significance of gender-sensitive attitudes in dealing with aggression and exploring attachment styles and reflective functioning.

Comparing stress levels in children aged 2–8 years and in their accompanying parents during first-time versus repeated voiding cystourethrograms

ZusammenfassungHINTERGRUND: Invasive Prozeduren wie die MCU bedeuten für Kinder und Eltern eine hohe Stressbelastung. Ziel der vorliegenden Studie war es, zu untersuchen, ob sich die Stressbelastung von Kindern und deren begleitenden Eltern bei erstmaliger und wiederholter Miktionszystourethrographie (MCU) unterscheidet. Darüber hinaus sollte die Beziehung zwischen elterlichem Verhalten (das kindliche Coping förderndes und den kindlichen Distress förderndes Verhalten), elterlicher Stressbelastung und kindlicher Stressbelastung bei erstmaliger und wiederholter MCU untersucht werden. METHODIK: In einer prospektiven Studie wurde das Distressverhalten von 31 Kindern im Alter von 2 bis 8 Jahren bei wiederholter MCU untersucht. Eine Parallelstichprobe von 31 Kindern mit erstmaliger MCU diente als Kontrollgruppe. Kindliches und elterliches Verhalten während der MCU wurde von drei unabhängigen Beobachtern mittels einer standardisierten Beobachtungsskala (CAMPIS-R, Blount et al.) kodiert. Die Kinder beurteilten ihre Stressbelastung anhand einer Gesichterskala. Eltern und Radiologen schätzten die kindliche Stressbelastung anhand einer visuellen Analogskala ein. Ergänzend schätzten die Eltern ihre eigene Stressbelastung ebenfalls auf einer visuellen Analogskala ein. ERGEBNISSE: Kinder mit wiederholter MCU unterscheiden sich in ihrer Stressbelastung nicht von Kindern mit erstmaliger MCU, die elterliche Stressbelastung ist jedoch bei wiederholter MCU signifikant geringer. In beiden Gruppen findet sich eine signifikante positive Korrelation zwischen Distress förderndem Verhalten der Eltern und kindlichem Distress, sowie zwischen elterlicher Stressbelastung und kindlichem Distress. Zwischen Coping förderndem Verhalten der Eltern und kindlichem Distress bzw. elterlicher Stressbelastung konnten in keiner der beiden Gruppen signifikante Korrelationen gefunden werden. Elterliche Stressbelastung und Distress förderndes Verhalten der Eltern waren nur bei wiederholter MCU signifikant positiv korreliert. Im Coping und Distress fördernden Verhalten der Eltern zeigten sich keine signifikanten Unterschiede zwischen erstmaliger und wiederholter MCU. SCHLUSSFOLGERUNGEN: Die kindliche Stressbelastung ist bei wiederholter MCU vergleichbar hoch wie bei erstmaliger MCU. Obwohl die elterliche Stressbelastung bei wiederholter MCU geringer ist, erweist sich das spontane Verhalten der Eltern als ineffektiv bzw. sogar kontraindiziert zur Verringerung der kindlichen Stressbelastung. In einem nächsten Schritt sollten weiterführende Studien zu effizienten Beratungs- und Trainingsprogrammen für Eltern und Kinder bei wiederholter MCU folgen.SummaryOBJECTIVES: Invasive procedures such as voiding cystourethrograms (VCUGs) cause distress in both children and their accompanying parents. The main purpose of this study was to examine whether stress levels in children and their parents differ during first-time and repeated VCUGs. The second objective was to examine the relationship between parental behavior (behavior promoting child coping and behavior promoting child distress), parental stress levels and child distress in first-time versus repeated VCUGs. METHODS: In a prospective study, the distress behavior of 31 children aged 2–8 years who were undergoing a repeated VCUG was examined. A second group of 31 children who were undergoing a VCUG for the first time served as a control sample. Child and parental behavior during the VCUG was coded by three independent observers using a standardized rating scale (CAMPIS-R, Blount et al.). Children reported on their stress levels using a faces scale; parents and radiologists rated the childs distress on a visual analog scale. Similarly, parents assessed their own stress levels on a visual analog scale. RESULTS: The stress levels of children undergoing a repeated VCUG do not differ from those of children undergoing a VCUG for the first time, but parental stress levels were significantly lower during repeated VCUGs. In both VCUG groups there was significant positive correlation between parental distress-promoting behavior and child distress, and between parental stress levels and child distress. Parental coping-promoting behavior showed no significant correlation with child distress or parental stress levels in either VCUG group. Parental stress levels and parental distress-promoting behavior correlated positively only for repeated VCUGs. Neither parental coping- nor distress-promoting behavior differed between first-time versus repeated VCUG groups. CONCLUSIONS: Repeated VCUGs and first-time VCUGs are both highly distressing procedures for children. Even though parental stress levels are lower during repeated VCUGs, spontaneous parental behavior proves to be ineffective or even counterproductive in reducing the childs distress. Further research into efficient counseling and training methods for parents and children undergoing VCUGs is required.

Psychiatric morbidity in gynecological and otorhinolaryngological outpatients: a comparative study

OBJECTIVE Assessment of the point prevalence of psychiatric disorders in a gynecological outpatient population compared to a control group consisting of otorhinolaryngological outpatients. METHODS During an 11-month period of time, 150 unselected, consecutive gynecologic outpatients and 150 matched controls (otorhinolaryngological outpatients) were enrolled in the study. Patients were screened for psychiatric disorders using the Patient Health Questionnaire (PHQ). Sociodemographic data, psychiatric and medical history including inpatient treatments and outpatient contacts, and utilisation of the health care system were assessed. RESULTS Within the gynecological group, 45.3% fulfilled the diagnostic criteria for at least one psychiatric diagnosis according to the PHQ, compared to 27.3% of the otorhinolaryngological control group (P=.002). With respect to distinct diagnoses, gynecological patients suffered significantly more often from somatoform disorders (P=.001) and depressive disorders (P=.003) than controls. Less than half of subjects of either group with any psychiatric diagnosis had ongoing psychiatric or psychotherapeutic treatment. CONCLUSIONS We found a significant group difference in the number of psychiatric diagnoses between gynecological and otorhinolaryngological female outpatients. Psychiatric disorders may be frequent and unrecognised in women presenting in an outpatient setting, especially in those seeking medical care for gynecological problems. The PHQ may be a useful tool to detect psychiatric disorders even in busy clinical settings.

Midday and nadir salivary cortisol appear superior to cortisol awakening response in burnout assessment and monitoring

Burnout and work-related stress symptoms of anxiety disorder and depression cause prolonged work absenteeism and early retirement. Hence, reliable identification of patients under risk and monitoring of treatment success is highly warranted. We aimed to evaluate stress-specific biomarkers in a population-based, “real-world” cohort (burnouts: n = 40, healthy controls: n = 26), recruited at a preventive care ward, at baseline and after a four-month follow up, during which patients received medical and psychological treatment. At baseline, significantly higher levels of salivary cortisol were observed in the burnout group compared to the control group. This was even more pronounced in midday- (p < 0.001) and nadir samples (p < 0.001) than for total morning cortisol secretion (p < 0.01). The treatment program resulted in a significant reduction of stress, anxiety, and depression scores (all p < 0.001), with 60% of patients showing a clinically relevant improvement. This was accompanied by a ~30% drop in midday cortisol levels (p < 0.001), as well as a ~25% decrease in cortisol nadir (p < 0.05), although not directly correlating with score declines. Our data emphasize the potential usefulness of midday and nadir salivary cortisol as markers in the assessment and biomonitoring of burnout.

A combination of routine blood analytes predicts fitness decrement in elderly endurance athletes

Endurance sports are enjoying greater popularity, particularly among new target groups such as the elderly. Predictors of future physical capacities providing a basis for training adaptations are in high demand. We therefore aimed to estimate the future physical performance of elderly marathoners (runners/bicyclists) using a set of easily accessible standard laboratory parameters. To this end, 47 elderly marathon athletes underwent physical examinations including bicycle ergometry and a blood draw at baseline and after a three-year follow-up period. In order to compile a statistical model containing baseline laboratory results allowing prediction of follow-up ergometry performance, the cohort was subgrouped into a model training (n = 25) and a test sample (n = 22). The model containing significant predictors in univariate analysis (alanine aminotransferase, urea, folic acid, myeloperoxidase and total cholesterol) presented with high statistical significance and excellent goodness of fit (R2 = 0.789, ROC-AUC = 0.951±0.050) in the model training sample and was validated in the test sample (ROC-AUC = 0.786±0.098). Our results suggest that standard laboratory parameters could be particularly useful for predicting future physical capacity in elderly marathoners. It hence merits further research whether these conclusions can be translated to other disciplines or age groups.