Katrin Imbierowicz

Temperament and character personality profiles and personality disorders in chronic pain patients

Abstract In his psychobiological model of personality, Cloninger developed a novel approach concerning the relationships between psychopathological syndromes and personality. We investigated 207 chronic pain patients (CPPs) and compared them to 105 pain‐free control subjects. Participants were assessed using the Temperament and Character Inventory (TCI), the Structured‐Clinical‐Interview‐II, the Beck Depression Inventory and the Spielberger Anxiety Inventory. The CPPs scored higher on the depression and state anxiety scales and 41% fulfilled the criteria of having at least one personality disorder (PD). We used a covariance analysis to control for depression and state anxiety and found that the CPPs scored higher on the Harm Avoidance Temperament Dimension and lower on the Self‐Directedness and Cooperativeness Character Dimensions. In CPPs, the symptom counts of all PD subtypes were significantly related to low Self‐Directedness and, to a lesser degree, low Cooperativeness. The PD symptoms in Cluster A were related to low Reward Dependence, those in Cluster B were related to high Novelty Seeking and the PD symptoms in Cluster C were related to high Harm Avoidance. In multiple hierarchical regression analyses, controlling for age, gender, depression and state anxiety, TCI scales predicted on average 23% in PD symptom counts. The Self‐Directedness and Cooperativeness personality traits appeared to be significant predictors in determining the presence or absence of a PD by correctly classifying 75.8% of CPPs. The TCI provides further insight into the mechanisms underlying the development of chronic pain. This useful diagnostic instrument helps to economically and validly facilitate the identification of core PD features.

Chorioretinopathia centralis serosa und psychische Belastung

ZusammenfassungHintergrund. Die Ätiologie der Chorioretinopathia centralis serosa ist bis heute nicht sicher geklärt. Vorangegangene Studien diskutierten u. a. inadäquate Bewältigungsstrategien und fehlende soziale Unterstützung bei Belastung als Auslösefaktoren. In der vorliegenden Untersuchung wurde der Frage nach einem Zusammenhang zwischen der Chorioretinopathia centralis serosa und psychischer Belastung nachgegangen. Patienten und Methode. 35 männliche Patienten mit Chorioretinopathia centralis serosa wurden mit einer Kontrollgruppe von 21 männlichen Patienten mit traumatischen Augenleiden verglichen. Neben soziodemographischen Daten und Krankheitssymptomatik wurden Persönlichkeitsfaktoren, kritische Lebensereignisse in der Vorgeschichte, Stressverarbeitung und körperliche Beschwerden untersucht. Ergebnisse. Die Patienten mit Chorioretinopathia centralis serosa zeigten signifikant mehr körperliche (nicht auf die Augensymptomatik bezogene) Beschwerden gemessen mit der Beschwerden-Liste (B-L). Im Freiburger Persönlichkeitsinventar zeigten sie eine höhere emotionale Labilität und Beanspruchung sowie eine niedrigere Extraversion. Schlussfolgerung. Die Ergebnisse der Untersuchung weisen in die Richtung einer höheren psychischen Belastung von Patienten mit Chorioretinopathia centralis serosa als Folge einer unangemessenen Bewältigung, die sich in einer verstärkten Äußerung körperlicher Beschwerden abbildet.AbstractBackground. To date we know little about the etiology of central serous chorioretinopathy. Former investigations discussed inadequate coping strategies and critical life-events as important psychological aspects. In this study we investigated the relationship between central serous chorioretinopathy and stress. Materials and Methods. 35 male patients with central serous chorioretinopathy (group1) were compared to 21 male patients with traumatic eye diseases. The evaluated data included sociodemographic data as well as data regarding the patients coping strategies, critical live-events before outbreak of the disease, personality factors and general physical complaints. Results. Group 1 showed a significantly higher amount of general physical complaints, measured with a complaints questionnaire (B-L). In a personality inventory (FPI-R) it scored significantly higher on the scales emotional instability and strain, significantly lower on the scale extraversion. Conclusion. The results indicate that patients with central serous chorioretinopathy are more stressed because of inadequate coping strategies, which can be seen in a higher amount of physical complaints.

Association between Anxiety and Factors of Coagulation and Fibrinolysis

Background: Psychological stress and anxiety have been shown to produce an activation of coagulation and fibrinolysis. Resulting hypercoagulability is a risk factor for cardiovascular diseases, and could therefore contribute to an increased prevalence of coronary artery disease in anxiety patients. However, hemostasis function has not yet been studied in patients with clinically relevant anxiety disorders. Methods: A group of anxiety patients (panic disorder with agoraphobia or social phobia) and a healthy control group (each n = 29) completed some questionnaires [SCL-K9 (a short form of the SCL-90-R), State Trait Anxiety Inventory, ADS (general depression scale)], and had blood drawn after a 15-min rest period. To assess the reaction of the hemostatic system by global entities, sum scores were computed from parameters of coagulation and fibrinolysis (fibrinogen, FVII, FVIII, vWF, F1 + 2, TAT, D-dimer, α2-AP, PAP, tPA, PAI-1). Interfering variables, such as age, gender, alcohol consumption and smoking status, were controlled. Results: Anxiety patients scored higher in a composite hemostatic score and a sum score of fibrinolysis in comparison to the control group, with a predominant activation of inhibitors in fibrinolysis. However, the psychological variable with the closest association to hemostasis was not trait anxiety, but self-perceived worry about blood drawing before blood sampling was performed. Conclusions: The coagulation and fibrinolysis system is activated in the direction of a hypercoagulable state in patients with severe phobic anxiety, triggered by fear of blood drawing. This could be one mediating factor for the increased risk of cardiovascular diseases in this population. Acute situational phobic anxiety should be monitored closely when studying the association between anxiety and hemostasis.

Magnetic resonance spectroscopic and relaxometric determination of bone marrow changes in anorexia nervosa.

Objective The objective of this study was to assess and quantify bone marrow changes in patients with anorexia nervosa using 1H magnetic resonance spectroscopy and relaxometry. Methods The bone marrow fat fraction and the longitudinal and transverse relaxation times (T1 and T2, respectively) of water were measured in the lumbar and femoral marrow of 20 patients with anorexia nervosa and 19 healthy control subjects. Results Patients with anorexia nervosa showed significant hyperhydration and reduction of the fat fraction in their bone marrow, predominantly in the proximal femur. These changes were associated with hematological abnormalities. In a retest of seven patients after psychotherapy and gain of weight, the pathological changes in marrow proved to be largely reversible in correlation with the increase in body mass index. Conclusions Fat depletion and excess of tissue water in the bone marrow in anorexia nervosa can be quantified by 1H magnetic resonance spectroscopy and relaxometry. The distribution of the pathological changes in the lumbar and femoral marrow follows the pattern of normal bone marrow conversion from hematopoietic to cellular during childhood.

Coagulation activation and fibrinolysis impairment are reduced in patients with anxiety and depression when medicated with serotonergic antidepressants.

Aims:  Anxiety disorders have been shown to be correlated with an activation of coagulation and impairment of fibrinolysis. The aim of the study was to assess whether medication with a serotonergic antidepressant, which has been associated with abnormal bleeding, may modify this effect.

Disclosing the cancer diagnosis: what contributes to patient satisfaction?

Despite the growing attention to the how, when and where of disclosing a cancer diagnosis, not all patients are satisfied with how the news is broken to them. As in German-speaking countries there is a lack of empirical studies on this subject, this analysis was conducted to determine how the cancer diagnosis was given in a German sample, and how satisfied the patients are with the disclosure experience. Patients and Methods: 162 outpatients received a self-report questionnaire focusing on their experiences with physician-patient communication when the diagnosis was disclosed. Results: Guidelines had been respected in most cases. 17% of patients were dissatisfied with the diagnosis disclosure. They reported a significantly shorter duration of the interaction, lack of privacy, deficits in understanding the information, and less emotional support by the physician. Conclusion: Adherence to guidelines of diagnosis disclosure in the German sample was fairly high. Respecting both informational and emotional needs is essential for patient satisfaction and can be taught in communication training.

Factorial structure of the 20-item Toronto Alexithymia Scale in a large sample of somatoform patients

Although a strong association between alexithymia and somatization has been postulated in numerous studies, no systematic study has investigated the psychometric properties of the 20-item Toronto Alexithymia Scale (TAS-20) in a sample of patients with somatoform disorder yet. The purpose of this study was to ensure a valid assessment by the German version of the TAS-20 in somatoform samples. We investigated whether the original three-factor model proposed by Bagby et al. (1994a), which is widely used in clinical research and practice, is replicable in a large sample of somatoform patients (n=806). Using confirmatory factor analysis (CFA) the goodness-of-fit of the originally proposed factor structure was compared to three factor models generated with exploratory factor analysis (EFA) and other factorial solutions derived from the literature. Our results demonstrate that the original three-factor model is not replicable in somatoform patients. Instead, the four-factor model by Franz et al. (2001b) described the data best. However, none of the models met all criteria of confirmatory factor analysis. Our results indicate that the three-factor model is not robust in the German version of the TAS-20. At this state of research we recommend to use the TAS-20 sum-score as a measure of alexithymia in somatoform patients in clinical practice.

Turning against self and its relation to symptom distress, interpersonal problems, and therapy outcome: A replicated and enhanced study

Abstract The relation of the turning against self defense mechanism to symptom distress, interpersonal problems, and therapy outcome was explored in 75 inpatients in a psychodynamic setting. In accordance with former studies, the patients showed a high initial level of turning against self, and its reduction during therapy was correlated with a good symptom reduction. The validity of the measurement of this mechanism by the FKBS, a German version of the Defense Mechanisms Inventory, was confirmed by high correlations with scales from the State-Trait Anger Expression Inventory and the Toronto Alexithymia Scale. A new issue was how turning against self correlated with interpersonal behavior. Patients with a frequent use of turning against self had more interpersonal problems, predominantly of the friendly–submissive type and significantly fewer of the domineering–hostile type. Identifying and reducing a strong turning against self, as well as challenging the related interpersonal behavior, thus represent central tasks in psychotherapy. A multimodal inpatient setting with a combination of psychodynamic and behavioral interventions proved to be effective. Finally, the question of favorable therapist variables is raised.

Impact of the Turning-Against-Self Defense Mechanism on the Process and Outcome of Inpatient Psychotherapy

The authors examined the relation between specific defense mechanisms and treatment process and outcome in psychodynamic psychotherapy. Three measures, Questionnaire for Conflict Coping Strategies, Questionnaire on the Experience of the Inpatient Therapeutic Process, and Symptom Checklist-90-R, were given to 65 inpatients of a psychosomatic clinic, predominantly with depressive or eating disorders. Turning against self was the most frequently used defense mechanism in the patient group. A high level of turning against self that could be reduced significantly during treatment was associated with good adaptation to treatment setting and positive treatment outcome defined by symptom distress reduction. Assessment of defense mechanisms and their interaction with therapeutic factors in the therapy setting can be useful to better understand the treatment process and the subsequent development of specific interventions to enhance treatment outcome.

Can activation of coagulation and impairment of fibrinolysis in patients with anxiety and depression be reversed after improvement of psychiatric symptoms? Results of a pilot study.

Abstract Anxiety and depression are associated with an activation of coagulation and impairment of fibrinolysis. This study addresses the question whether these findings are reversed after psychotherapy and improvement of psychiatric symptoms. Three factors of coagulation and fibrinolysis as well as level of anxiety and depression were reassessed in 12 patients 1 to 3 years after intensive inpatient psychotherapy. The patients showed a substantial improvement of their severe anxiety disorder and comorbid depressive disorder. Simultaneously, we found a significant decrease in factor VII and plasminogen activator inhibitor. We conclude that reduction of severe anxiety and depression may be associated with a reversal of the procoagulant effect (activation of coagulation and impairment of fibrinolysis) of these psychological states. Because of the small sample size of this pilot study, further research is needed.