Frank Petrak

Impaired Health-Related Quality of Life in Inflammatory Bowel Diseases Psychosocial Impact and Coping Styles in a National German Sample

Background: The purpose of this study is to give a detailed survey of the disease-specific and generic quality of life (HRQOL) of adult patients suffering from inflammatory bowel disease (IBD) in Germany. Methods: 1322 patients suffering from IBD were examined in a cross-sectional study. A questionnaire assessing disease-specific and generic quality of life, coping, and hopelessness was sent to members of the German Crohn/Colitis association. Results:

Treatment of depression in diabetes: an update.

Purpose of review The combination of depression and diabetes is common and especially harmful because depression has a strong impact on psychosocial as well as medical outcomes in patients with diabetes. Consequently, treatment for depression in diabetes is also aimed at improvement in glycemic control and risk reduction for diabetes complications and mortality. This review provides an overview of all published, randomized controlled trials on the treatment of depression in patients with diabetes and summarizes current, ongoing research. Recent findings The best results for medical and psychological outcomes were observed for psychological treatments; however, the generalizability of these results is restricted by methodological limitations. Most antidepressants were effective treatments for depression in diabetes but failed to show benefits regarding diabetes-related medical variables. Algorithm-based care, including psychological and psychopharmacological approaches, provides the best scientific evidence for successful depression treatment but not for glycemic control. Summary Depression can be treated with antidepressants, psychotherapy or a flexible combination of both with relatively good results that are comparable to those for patients who have depression but not diabetes. Up to now, no single treatment that consistently leads to better medical outcomes in patients with both depression and diabetes has been clearly identified.

Psychosocial Factors and Diabetes Mellitus: Evidence-Based Treatment Guidelines

The aim of this project was to develop evidence-based guidelines regarding psychosocial aspects of diabetes mellitus in an effort to help the clinician bridge the gap between research and practice. Recommendations address the following topics: patient education, behavioural medicine, and psychiatric disorders of particular relevance to diabetes: depression, anxiety disorders, eating disorders, and dependence on alcohol and nicotine. The present guidelines were developed through an interdisciplinary process of consensus according to the specifications of evidence-based medicine and are recognized by the German Diabetes Association and the German College for Psychosomatic Medicine as their official guidelines.

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.

Prevalence of psychiatric disorders in an onset cohort of adults with type 1 diabetes

Previous studies indicate a high prevalence of psychiatric disorders in adults with type 1 diabetes mellitus. The aim of our study was to determine if newly diagnosed adults with type 1 diabetes already have an elevated rate of psychiatric disorders at the beginning of their physical illness.

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...

Cortisol, platelet serotonin content, and platelet activity in patients with major depression and type 2 diabetes: an exploratory investigation.

Objective Hypothalamic-pituitary-adrenal system dysfunction, serotonergic system alterations, and enhanced platelet activity may contribute to the increased cardiac risk in depression. This exploratory study examined associations between cortisol parameters, platelet serotonin (5-HT) content, and platelet activity markers in patients with newly diagnosed major depression (MD) and/or Type 2 diabetes (T2DM) compared with healthy controls. Methods We compared cortisol awakening response (CAR), diurnal decrease in salivary cortisol concentrations (slope), platelet 5-HT, and platelet markers (CD40, CD40 ligand [CD40L], soluble CD40L, CD62P, &bgr;-thromboglobulin, and platelet factor-4) in 22 T2DM patients, 20 MD patients, 18 T2DM patients with MD, and 24 healthy controls. Results Platelet markers were elevated in MD (F(6,60) = 11.14, p < .001) and T2DM (F(6,60) = 13.07, p < .001). Subgroups did not differ in 5-HT or cortisol slope, whereas T2DM patients without depression had significantly lower CAR than did healthy controls (F(1,61) = 7.46, p = .008). In healthy controls, cortisol slope correlated with platelet activity for CD40 (r = −0.43, p = .048) and 5-HT was correlated with CD40L (r = 0.53, p = .007). In patients with both T2DM and MD, 5-HT and CD62P were correlated (r = 0.52, p = .033). Conclusions Increased platelet activity in T2DM and MD may play a role in the association between diabetes, depression, and coronary artery disease. The present data suggest that group differences in cortisol or 5-HT as well as group-specific associations of cortisol or 5-HT with platelet markers might be of limited importance in the shared pathways of T2DM and depression in the pathophysiology of coronary artery disease.

Ess-Störungen und Diabetes mellitus

Adolescent and young women with type 1 diabetes mellitus demonstrate a more than random coincidence with bulimia nervosa. However, the prevalence of eating disorders that do not fulfil the criteria of bulimia nervosa is also raised in women of this age group yet without diabetes mellitus. The comorbidity of type 1 diabetes and an eating disorder poses a risk factor in the development of diabetic follow-up diseases. Patients with an eating disorder and type 1 diabetes are characterized by an insufficient metabolic control and the early development of diabetic complications such as a retinopathy. The binge eating disorder, according to research aspects initially a new eating disorder entity, may especially be observed in overweight and obesity. Even if a binge eating disorder in persons with a type 2 diabetes does not occur more frequently than in those metabolically healthy persons, it does depict a risk factor for an accelerated weight gain which as rule involves an increase of insulin resistance.

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.

Alkohol und Rauchen bei Diabetes

ZusammenfassungAlkohol und Tabak gehören zu den ältesten Genussmitteln der Menschheit. Ihr Konsum ist bei Diabetes jedoch mit zusätzlichen gesundheitlichen Risiken verbunden. Allerdings gilt bei einer Bewertung einer möglichen schädlichen Wirkung von Alkohol und Tabak die Erkenntnis von Paracelsus: „Alle Dinge sind Gift, und nichts ist ohne Gift. Allein die Dosis macht, dass ein Ding kein Gift ist“. In der Praxis ist es eine nicht einfache Aufgabe, zwischen einem gesundheitlich unbedenklichen Konsum von Alkohol und einem schädlichen Gebrauch oder sogar einer Abhängigkeit von Alkohol und Tabak zu unterscheiden. Maßgeblich für die Unterscheidung sind sowohl die Konsummenge, das Konsumverhalten wie auch die Konsequenzen des Konsums.