Gabriele Helga Franke

Alexithymia and Outcome in Psychotherapy

Background: About 25% of all patients seeking psychotherapeutic treatment are considered to be alexithymic. Alexithymia has been assumed to be negatively associated with therapeutic outcome. On the other hand, it is unclear to which extent alexithymia itself may be modified by psychotherapeutic interventions. Methods: From 414 consecutively admitted inpatients, 297 were followed up after 4 weeks (t1) and after 8–12 weeks (t2) upon discharge. Patients were treated with psychodynamic group therapy in a naturalistic setting. The Toronto Alexithymia Scale (TAS-20) and the Symptom Checklist-90 were administered. Results: Twenty-seven percent of the patients were alexithymic (TAS-20 ≧61) at baseline. Multivariate models with repeated measurements indicated significant changes in Global Severity Index of the Symptom Checklist-90 in both alexithymic and nonalexithymic subjects. However, alexithymic subjects had significantly higher Global Severity Index scores than nonalexithymic subjects at t0, t1 and t2 (p < 0.001). The TAS-20 scores demonstrated a high relative stability in the total sample. However, in the alexithymic group, the TAS-20 scores changed considerably from baseline to discharge [66.3 (SD = 4.7) to 55.9 (SD = 9.9); t = 8.69; d.f. = 79; p < 0.001]. Conclusion: The inpatient treatment program including psychodynamic group therapy significantly reduced psychopathological distress and alexithymic features in alexithymic patients. Still, these patients suffered from higher psychopathological distress at discharge than nonalexithymics. Therefore, alexithymic features may negatively affect the long-term outcome.

Living-related liver transplantation from the view of the donor: A 1-year follow-up survey

Background. In the past, follow-up surveys for living-related liver transplantation (LRLT) mainly focused on the medical outcome of recipients and donors. In this survey the prevalence of personal, familial, or economic problems of the donors and changes of quality of life after donation were studied. Methods. Questionnaires were sent to 24 donors after right hepatectomy for LRLT (response 92%). The modified EUROTOLD (European Multicenter Study of Transplantation Using Living Donors) questionnaire was used to inquire about the decision-making process, family problems, and economic problems related to the donation. Global quality of life was measured with the SF-36 Health Survey. Results. For most donors the decision to donate was easy or not very difficult (21/22) and was made spontaneously (17/22). The amount of information about the risks of LRLT was limited at the time of decision but increased remarkably immediately before the operation. In 28%, family conflicts occurred (5/22). Retrospectively, all but two donors (91%) would donate again. On average, donors started working after 9 (±3.7) weeks and felt fully recovered after 13 (±7.3) weeks. Adverse financial affects were experienced by 41% of the donors (9/22) because of the donation, and four of those received a compensation. Importantly, quality of life did not differ between donors and nondonors. Conclusion. Donors viewed LRLT positively. Quality of life after donation did not change. However, donors had a prolonged period of physical rehabilitation, and 41% experienced financial disadvantages.

The Impact of Living-Related Kidney Transplantation on the Donor's Life

Background. Living-donation kidney transplantation (LDKT) is increasingly performed for treatment of chronic renal failure. Recently, risks for the donor and problems in decision-making have been stressed. This study was conducted to illuminate the decision making-process and consequences of LDKT on family life, the financial and occupational situation. Moreover, quality of life (QOL) and mental distress were explored. Methods. All German residents at Essen University, who donated their kidney between 1999 and 2003, were included in the study. Donors filled out the questionnaire of the European Multicenter Study of Transplantation Using Living Donors, the Short Form 36-Health Survey, and the Brief Symptom Inventory. Results. Out of a total of 65 donors, 47 replied (72%) at an average 2.5 years postdonation. No fatalities occurred in the whole sample (n=65), medical complications were experienced by 28%. Most donors decided voluntarily (94%) and spontaneously (66%) to donate, after donation 96% stated that they would decide in the same way again. QOL was within the norm. On the other hand, 10% experienced family conflicts, every eighth donor suffered from clinically relevant distress, financial disadvantages were experienced by every fourth donor, with 25% not answering this question. Conclusion. Seen from the donor’s perspective, LDKT is a relatively safe procedure. However, increased rates of donors with mental distress and intra-familial conflicts emphasize the need for a careful selection process. Regular postdonation psychosocial screening and provision of specific interventions to those in need are recommended. Donors should not suffer from financial and occupational disadvantages resulting from donation.

Quality of Life in End-Stage Renal Disease Patients after Successful Kidney Transplantation: Development of the ESRD Symptom Checklist - Transplantation Module

The End-Stage Renal Disease Symptom Checklist – Transplantation Module (ESRD-SCL®) was developed to assess the specific physical and psychological quality of life of renal transplant recipients, with a special focus on side effects of immune system suppression therapy. A list of potentially relevant items was administered to 458 transplant recipients. The symptoms present in >20% of patients were chosen, and factor analysis was used to create the final questionnaire which consists of 43 items in six dimensions: (1) limited physical capacity (10 items; internal consistency: Cronbach’s α = 0.85); (2) limited cognitive capacity (8 items, α = 0.82); (3) cardiac and renal dysfunction (7 items, α = 0.76); (4) side effects of corticosteroids (5 items, α = 0.77); (5) increased growth of gum and hair (5 items, α = 0.78), and (6) transplantation-associated psychological distress (8 items, α = 0.80). All questions are scored on a five-point Likert scale. Validity was demonstrated in correlation with corresponding SF-36 scales and in a stepwise hierarchical regression model predicting the subscales of the ESRD-SCL by sociodemographic and medical data. The ESRD-SCL was found to have adequate reliability, test-retest correlations in a subsample of 88 stable patients after 1 year, and construct validity.

Aspects of quality of life through end-stage renal disease

This study was conducted to explore differentiated aspects of quality of life (QoL) throughout the course of end-stage renal disease (ESRD) with special regard to kidney transplantation (KTX). In detail two questions were addressed: (1) does social support change over time? and (2) is psychological distress a predictor of generic and disease-specific QoL? Two groups of ESRD-patients were investigated twice with different psychodiagnostic inventories. At t0 the Brief Symptom Inventory (BSI) and a validated German Social Support Questionnaire were administered. At t1 social support as well as generic and disease-specific QoL were investigated (SF-36, End-Stage Renal Disease Symptom Checklist-Transplantation Module [ESRD-SCLTM]). Group A consisted of 80 patients treated by dialysis while on the waiting list for transplantation when investigated at t0 and was followed after successful transplantation at t1. Group B consisted of 222 patients investigated twice after successful KTX. Groups A and B did not differ with respect to clinical data and comorbidity, except for stronger immunosuppression in transplanted patients of group A. Group A demonstrated a statistically significant (5% explanation of variance) increased satisfaction with social support after KTX, whereas group B reported a decrease. The psychological distress at t0 predicted QoL at t1 in both groups (2–13% explanation of variance of SF-36, ESRD-SCLTM-scores). High psychological distress on dialysis and after KTX is a predictor for low long-term QoL.

Quality of life in patients before and after kidney transplantation

Abstract The aim of the present study was to differentially determine quality of life (QOL) in patients with end-stage renal disease (ESRD) after successful kidney transplantation (RT, Group A) compared with ESRD patients on a waiting list for RT (Group B). and with healthy controls (Group C) because opinions vary as to which treatment modality can best assure ESRD patients a high QOL. Groups A, B and C each consisted of 149 persons, matched for age and gender. The Munich Quality of Life Dimensions List (MLDL) was used to measure global aspects of QOL. Distinct aspects of QOL were investigated by the Brief Symptom Inventory (BSI) and the Questionnaire for Social Support (K-22). Groups A and C reported similar QOL. Which was significantly higher than in group B (p < .0001). This was particularly true for the physical and psychological status and daily activities, but not for the social situation. Groups A and B reported similar social support, which was significantly, lower than in group C (p < 006). Both ESRD groups reported higher satisfaction with social support than healthy controls (p < .0001). Successful RT nor only improved distinct aspects of QOL in patients with ESRD, but even put them on par with healthy controls regarding physical and psychological QOL. Lower social support and higher satisfaction with social support in both groups of ESRD patients should be evaluated further. From a clinical viewpoint. the improvement of physical and psychological aspects of QOL in RT patients is impressive; but more attention should be paid to constantly low social support in this group of patients. International multi center longitudinal studies to investigate QOL in ESRD patients under different treatments am necessary.

Quality of life in kidney recipients: comparison of tacrolimus and cyclosporine-microemulsion

Treatment of end‐stage renal disease (ESRD) is evaluated by survival, quality of life (QOL) and cost‐effectiveness. Little is known about the influence of immunosuppressive agents on global and disease‐specific QOL in kidney recipients.

[The usefulness of the Brief Symptom Inventory 18 (BSI-18) in psychotherapeutic patients].

The BSI-18, an abridged version of the Brief Symptom Inventory of Derogatis, contains the 3 six items scales Somatization, Depression, Anxiety, and the Global Score (GSI). In a sample of N=638 psychotherapeutic patients, reliability and validity were proven. Reliability of the 3 scales was good: Somatization α=0.79, Depression α=0.84, Anxiety α=0.84, and GSI α=0.91. The postulated three-factor structure was proven sufficiently using confirmatory and explorative factor analyses. The questionnaire separated different patients groups. Judgments of the therapists corresponded well with the self-rating behavior of the patients. In conclusion, the psychometric evaluation of the BSI-18 resulted in persuasive evidence for its reliability and validity. The loss of information, as a result of item reduction, is acceptable analyzing large samples; in cases of individual analyses, the SCL-90-R is advised.

Quality of life in patients with malignant choroidal melanoma after radiotherapy

BackgroundPatient-orientated endpoints have attracted little attention in patients with malignant choroidal melanoma. This study was conducted to explore the long-term effects of malignant choroidal melanoma and radiotherapy on QOL by means of a differentiated and modular QOL approach, including global QOL, social support, and mental health, in comparison with sociodemographically matched healthy controls.MethodsA random sample of 100 outpatients treated by radiotherapy were asked by mail to take part in a psychodiagnostic study [instruments: Short-Form 36 Health-Survey (SF-36), Symptom Checklist-90-Revised, German Social Support Questionnaire]. The same instruments were applied to a healthy control group, which was matched to patients with regard to age, gender, and vocational situation.Results93 patients (average age 61.2 years) responded at an average of 5.5 years (±3.7) after diagnosis. Visual acuity in the affected eye decreased considerably from diagnosis (0.49±0.30) to participation in the study (0.09±0.21). Compared with healthy controls, patients reported on average statistically significantly lower global QOL (SF-36), whereas social support and mental distress did not differ. Frequencies of clinically relevant mental distress were significantly higher in patients than in controls (35.5% vs. 16.1%). Mental distress was associated with poorer visual acuity, but not with the extent of loss of visual acuity or number of follow-up treatments.ConclusionPatients with choroidal melanoma suffer from low long-term global QOL, and every third patient suffers from relevant mental distress. Regular screening for mental distress should be implemented along with psychological counseling. Additional follow-up treatment does not seem to induce mental distress.

Psychometric analysis of the brief symptom inventory 18 (BSI-18) in a representative German sample

BackgroundThe BSI-18 contains the three six-item scales somatization, depression, and anxiety as well as the Global Severity Index (GSI), including all 18 items. The BSI-18 is the latest and shortest of the multidimensional versions of the Symptom-Checklist 90-R, but its psychometric properties have not been sufficiently clarified yet.MethodsBased on a representative sample of N = 2516 participants (aged 14–94 years), detailed psychometric analyses were carried out.ResultsThe internal consistency was good: Somatization α = .82, Depression α = .87, Anxiety α = .84 and GSI α = .93. Confirmatory factor analysis supported the three scales as second-order and GSI as first-order factors. The model fit based on RMSEA is good but that model fit based on CFI and TLI are too low.ConclusionsTherefore, it is a very short, reliable instrument for the assessment of psychological distress. The BSI-18 can be used to reliably assess psychological distress in the general population. However, further studies need to evaluate the usefulness of standardization in clinical samples.