Friedrich Balck

Effect of psychotherapy and relaxation on the psychosocial and somatic course of Crohn's disease: main results of the German Prospective Multicenter Psychotherapy Treatment study on Crohn's Disease.

OBJECTIVE Few studies have been published on the influence of psychotherapy on the physical and psychosocial course of Crohns disease (CD). METHODS The present study, a prospective, randomized multicenter investigation conducted with 108 of 488 consecutive CD patients, was designed to investigate the influence of short-term psychodynamic therapy and relaxation in addition to a standardized glucocorticoid therapy on the somatic course of the disease as well as on patient psychosocial status. Based on the same standardized somatic treatment, the psychotherapy and control groups were compared after a 1-year treatment period and a follow-up of another year with regard to somatic course and psychosocial situation. RESULTS A total of 81 (75%) of 108 randomized patients completed the psychosocial follow-up. The comparison between the therapy groups after 1 year showed no significant differences in the four main target criteria of psychosocial status (depression, anxiety, psychosocial-communicative status and health-related quality of life). The mean Becks Depression Inventory (BDI) score at admission was 12.3 in the psychotherapy group and 8.7 in the control group. At the 1-year follow-up, the scores for depression have been 7.8 (psychotherapy group) and 7.8 (control group). In the 2-year follow-up, 84 patients were classified into four groups on the basis of somatic course; 23% of the control group and 30% of the psychotherapy group showed episode-free courses, 29% and 17% respectively underwent surgery due to failure of immunosuppressive or medical therapy, and a further subranking showed no significant differences between the two groups (P=.125). At the 1-year follow-up, the scores for depression of patients with an active episode respective remission were 14.6 vs. 5.8. From the patients point of view, at the end of the 2-year follow-up, the overall subjective evaluation of the effectiveness of psychotherapy was positive. CONCLUSION The patients included showed no psychosocial disturbances of clinical relevance. Although a tendency toward fewer surgical interventions, fewer relapses and reduction of depression was noted, the analysis was unable to demonstrate any benefit from psychosocial intervention on hypothesized parameters of psychosocial status and somatic course. Further studies should be performed to identify patient subgroups that may benefit from psychosocial intervention.

Deutsche Adaptation der Restraint Scale zur Erfassung gezügelten Essverhaltens

Zusammenfassung. Mit dem Konstrukt des gezugelten Essverhaltens wird die Kontrolle der Nahrungsaufnahme mit der Absicht, eine Gewichtsreduktion zu erreichen, bezeichnet. Diesem Essstil wird eine zentrale Rolle bei der Entstehung von Adipositas und Essstorungen zugeschrieben. Eines der international am weitesten verbreiteten Verfahren zur Erfassung gezugelten Essverhaltens ist die Restraint Scale (RS) von Herman und Polivy (1980). In der vorliegenden Studie wurde die Reliabilitat und Validitat der deutschen Form der RS bei einer Stichprobe von N = 349 Studenten untersucht. Die zweifaktorielle Struktur der RS konnte exakt repliziert werden. Die Gesamtskala weist ein Cronbachs Alpha von .83 auf. Bezuglich der Kriteriumsvaliditat der RS zeigten sich signifikante Unterschiede zwischen Mannern und Frauen. Weiterhin hatten gezugelte Esser einen signifikant hoheren BMI und sie berichteten ein hoheres Mas an dysfunktionalen Einstellungen im EDI. Hinweise auf die Konstruktvaliditat zeigten sich durch signifikante Korrelationen der RS mit Skalen des EDI und Masen der psychischen Befindlichkeit (ADS, BAI, SCL-K-9). Schlusselworter: Restraint Scale, Reliabilitat, Validitat, Gezugeltes Essverhalten, Studenten German version of the Restraint Scale for the assessment of restrained eating

Cognitive functioning in allogeneic hematopoietic stem cell transplantation recipients and its medical correlates: a prospective multicenter study.

Owing to its neurotoxicity, allogeneic hematopoietic stem cell transplantation (HSCT) carries risks for cognitive impairment. In this multicenter study, we prospectively evaluated cognitive functioning and its medical and demographic correlates in patients undergoing allogeneic HSCT.

An Evaluation of the German Relationship Assessment Scale

The Relationship Assessment Scale (RAS) is a short seven-item measure for the assessment of relationship satisfaction. It can be used with different types of relationships. We aimed to investigate the psychometric properties of the German version of the RAS in a community sample of N = 145 persons. The principal component analysis revealed one general factor, which accounted for more than 60 per cent of the variance. The internal consistency of the RAS was high (α = .89). While there were no significant associations between RAS scores and age or gender, several other sociodemographic parameters had an impact on the RAS, e. g. presence of children. The RAS correlated significantly with scales of the Dyadic Adjustment Scale (DAS), most impressively with the DAS satisfaction scale (r = .87). Persons living in a distressing relationship, as indicated by a DAS total score below 100, also had lower scores on the RAS. In conclusion, our results extend the evidence on the reliability and validity of the RAS.

Psychometrische Analyse der deutschen Dyadic Adjustment Scale

Zusammenfassung. Die Dyadic Adjustment Scale (DAS) ist international das am haufigsten eingesetzte Verfahren zur Erfassung der Beziehungsqualitat. Allerdings liegen nur wenige Ergebnisse zur psychometrischen Qualitat der deutschen DAS vor. In der vorliegenden Studie wurde die Faktorenstruktur der DAS an einer Stichprobe von N = 194 Personen der Allgemeinbevolkerung untersucht. Eine drei-faktorielle Losung, die die Skalen Zufriedenheit, Kohasion und Konsens reprasentiert, erwies sich als angemessen. Es zeigten sich Unterschiede im Ladungsmuster gegenuber dem Original; die Originalskala Affektiver Ausdruck lies sich nicht replizieren. Die Gesamtskala sowie die Subskalen wiesen eine gute interne Konsistenz auf (Gesamtskala α = .90). Wir entwickelten eine Kurzskala der DAS, die mittels je vier Items die drei Subskalen der deutschen DAS erfasst (DAS-12). Die Subskalen sowie die Gesamtform der Kurzskala weisen eine zufrieden stellende interne Konsistenz auf (DAS-12 Gesamt: α = .79). Korrelative Analysen liefern...

Problems in Interaction between Patients Undergoing Long-Term Hemodialysis and Their Partners

186 patients undergoing hemodialysis and their partners were examined with a personality inventory (Giessen test) and a questionnaire which was specially developed for this purpose. The instrument was used to measure the social interaction between patient and partner. The Giessen test was applied in four versions: self-description, description by the partner, referring to the present, referring to the past. One of the main interests of the analyses was in finding dependencies of the variables upon the types of hemodialysis setting (unit, private unit, and at home). Various correlations were found.

Attitudes toward genetic testing in a german population.

AIMS Population-representative or population-based studies on attitudes toward molecular genetic testing have so far been conducted in the United States, Great Britain, the Netherlands, and Finland. In 2001 our group conducted a representative survey for a German population among a total of 2076 respondents aged 14-95 years. The questionnaire administered consisted of 13 items covering the advantages and disadvantages of molecular genetic testing for hereditary diseases. We conducted a factor analysis to explore potential sub-dimensions of attitudes, and describe here the influence of sociodemographic variables on these sub-dimensions and how the attitudes of the Germans compare to those of the Finns. RESULTS Our factor analysis of the results showed three dimensions: approval, disapproval, and concern regarding genetic testing. In the German sample we found an overall positive attitude toward genetic testing. There was no influence of sex, but there were marked differences regarding age, educational backgrounds, and religious affiliation. Finns are more in favor of genetic testing and disapprove less than Germans. We can summarize that Germans have a markedly more skeptical view than Finns. In our opinion this could well be understood in the context of German history. We assume that this created a less conducive environment for the population to form a clearer attitude toward genetic testing as compared to the Finns. CONCLUSIONS In the light of our results there is certainly a need for more information and education. Further, it would in our opinion be most useful if the German development regarding attitudes to genetic testing, especially after reunification, is studied longitudinally to provide a better understanding of possible developments.

Psychische Symptome bei Studentinnen in Ost- und Westdeutschland: Eine Replikation nach 10 Jahren

Psychological Symptoms in Female University Students in East and West Germany: A Replication after 10 Years Background: After the German unification, several studies have focused on differences in the psychological health of people in East and West Germany. The current study is a replication of the Basten et al. study [Psychological wellbeing and health in a unified Germany: An East-West-comparison of two student samples. Verhaltenstherapie 1994;4:90–95] 10 years after the original research of 1991/1992. It investigated differences in depression, anxiety and bodily symptoms as well as problematic eating behaviour in female university students in Dresden (East Germany) and Marburg (West Germany). Subjects and Methods: From October 2001 to April 2002, we investigated psychological symptoms and eating behaviour in students of the universities of Dresden and Marburg. The current report includes data of 221 female students. We used the same standardized measures as had been used in the original research. Results: In contrast to the original study, students from West Germany did no longer exhibit higher depression scores. Instead, students from East Germany showed significantly increased anxiety symptoms. Furthermore, there was a trend towards a higher drive for thinness in East German students. In all, students from Dresden showed higher mean values in all measures than 10 years before. Discussion: This study corroborates results that there are only minor differences in psychological health between people in East and West Germany. However, our findings point out that during the past decade subtle changes might have occurred which have not been detected through lack of longitudinal investigations. The higher level of anxiety in East German students could be a result of socialisation.

Notärzte im Umgang mit psychisch belastenden Einsatzsituationen

ZusammenfassungIn der vorliegenden Arbeit werden Reaktionen von 20 Notärzten nach über 260 Reanimationen bzw. Todesfeststellungen in einer retrospektiven Fragebogenstudie durch die Erfassung der Emotionen sowie der Kommunikation der Ärzte beschrieben.In den Daten konnten Bedingungen identifiziert werden, die dem Notarzt den Umgang mit der psychischen Belastung der Reanimationssituation erschweren. Dazu gehören das Alter und die Berufserfahrung, aber auch der Familienstand und das Erleben eigener Trennungsprozesse. So zeigen junge Ärzte nach einer Reanimation ein Muster von emotionaler Vermeidung und Überaktivität, während erfahrene Ärzte weniger dazu neigen. Ärzte mit vor kurzem erlebten Trennungserlebnissen scheinen weniger bereit, in eine Auseinandersetzung mit Verlusten einzutreten. Daher scheint es, dass für jüngere, weniger berufs- und notfallmedizinisch erfahrene Ärzte ebenso wie für Ärzte mit erschwerender persönlicher Lebenssituation zusätzliche Möglichkeiten der emotionalen Entlastung hilfreich wären.Konkrete Vorschläge für den einzelnen Notarzt und das Vorgehen im Rettungsteam für die Zeit des Einsatzes sowie danach einschließlich Empfehlungen zur sog. “Fallsupervision” werden dargelegt.AbstractReactions of 20 physicians to more than 260 situations of cardiopulmonary resuscitations were examined using a retrospective study of their emotions and communication pattern.Coping strategies of physicians vary: Young physicians show a pattern of emotional denial whilst being active in their resus-citation behaviour. More experienced doctors tend to deny less. Physicians with a history of recent loss seem to be reluctant to cope emotionally. Discussing the situation seems to improve coping behaviour. Active behaviour during the emergency seems to result in relieve for a short time, however, long term coping seems to be impaired.In our data we could identify variables which make coping more difficult to achieve. Amongst others these were age and experience of the physician, maritial status and a history of recent loss. Younger, less experienced physicians and those with recent losses seem to be in need of support. Suggestions to improve the situation of the emergency physician and the team are made with special regards to the time after the emergency and supervision.

Gesundheit durch Gentests

Zusammenfassung. Pra- und postnatale genetische Diagnostik zur Ermittlung eines individuellen Erkrankungsrisikos gewinnt zunehmend an Bedeutung. Dementsprechend sind genetische Untersuchungen des menschlichen Erbgutes sowie damit verbundene Anwendungsbereiche Gegenstand intensiver gesellschaftlicher Diskussion. Zu den moglichen Vor- und Nachteilen genetischer Untersuchungen wurde eine deutschlandreprasentative Stichprobe (N = 2.076 Personen) befragt. Die Ergebnisse zeigen, dass genetische Untersuchungen insgesamt auf eine grose Akzeptanz in der Bevolkerung stosen, ca. zwei Drittel stehen ihnen befurwortend gegenuber. Jedoch werden auch mogliche Nachteile solcher diagnostischer Masnahmen, wie z.B. Schwangerschaftsabbruche oder Diskriminierung, benannt. Faktorenanalytisch liesen sich aus den 13 Items des eingesetzten Fragebogens drei Skalen (Positive Aspekte, Negative Aspekte, Befurchtungen) bilden. Eine Varianzanalyse erbrachte Unterschiede in den Skalen zwischen verschiedenen soziodemographischen Gruppen:...