Ralf Nickel

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.

Associations among attachment characteristics, patients’ assessment of therapeutic factors, and treatment outcome following inpatient psychodynamic group psychotherapy

Abstract Within a multisite study, including 289 inpatients from six different hospitals who underwent interpersonal-psychodynamic group psychotherapy, associations among attachment characteristics, therapeutic factors, and treatment outcome were investigated. Attachment characteristics were assessed with an interview-based measure (Adult Attachment Prototype Rating [AAPR]) as well as an attachment self-report (Bielefeld Questionnaire of Client Expectations [BQCE]). Therapeutic factors were measured retrospectively with the Düsseldorf Therapeutic Factors Questionnaire and treated as an individual- as well as a hospital-specific characteristic. On an individual level, only the group climate factor independently predicted treatment outcome (i.e., Symptom Checklist-90-R Global Severity Index and Inventory of Interpersonal Problems mean). If simultaneously but separately included into a path model, analyses revealed independent significant effects of AAPR-Security and BQCE-Security on group climate. If modeled as a latent variable (common attachment security), a substantially higher proportion of group climate variance could be explained. Further analyses revealed interactions between particular therapeutic factors and attachment characteristics, indicating a particular importance of these therapeutic factors for different attachment categories.

Are childhood adversities relevant in patients with chronic low back pain

Previous studies have found a high number of childhood adversities in patients with chronic low back pain, particularly in patients reporting persisting problems after back surgery. Our aim was to reproduce these results.

Parentifizierung in der Kindheit und psychische Störungen im Erwachsenenalter

BACKGROUND Emotional parentification is considered harmful to a childs development. METHOD A total of about 975 patients were examined at a Department of Psychosomatic Medicine and in the practices of general practitioners with regard to childhood adversities. RESULTS Emotional parentification is a risk factor for 2 symptom groups: the patients with depression and the patients with somatoform pain. While the occurrence of depression is mainly predicted by maternal emotional parentification, paternal influences are also relevant in regard to the development of somatoform pain. CONCLUSION Emotional parentification is an important risk factor for the occurrence of psychological and somatoform complaints in adulthood. This is especially apparent in combination with further risk factors, such as low reported values for love, sexual abuse, or being raised without a father.

Three-dimensional crystallization of the light-harvesting complex from Mantoniella squamata (Prasinophyceae) requires an adequate purification procedure

Abstract We present a new purification procedure for the light-harvesting complex of Mantoniella squamata whereupon three-dimensional crystallization succeeded. Previous purification methods were based on density centrifugations as the only separating principle. We have extended this preparation procedure by applying anion-exchange and molecular-sieve chromatography techniques. Purity and stability of the complex were proved by denaturing and non-denaturing polyacrylamide-gel electrophoresis, and spectroscopic measurements. With respect to contaminating lipids the purified pigment-protein complex was examined by thin-layer chromatography and the aggregation and/or oligomeric states were investigated by gel filtration, fluorescence emission, and electron microscopy. Molecular-mass determination by gel filtration gave evidence for a trimeric organization of the purified native complex. Our purification procedure resulted in mixed protein-detergent micelles, small and homogeneous, the ideal material to start crystallization trials. We found involuntary aggregation to be easily detected by additional fluorescence emission at red-shifted wavelength (700 nm) as compared to the main emission at 680 nm. Electron-microscopic images proved this emission at 700 nm to be really due to aggregation, which could be prevented if sufficient detergent were present in the samples during the whole purification procedure. The ultimate proof that our efforts have been successful was the appearance of hexagonal crystals.

Influence of childhood adversities and defense styles on the 1-year follow-up of psychosomatic- psychotherapeutic inpatient treatment

Abstract The current study explores the connection between reported sexual abuse and physical maltreatment during childhood and immature defense styles as affecting the 1-year follow-up of inpatients who had undergone psychodynamic group therapy. Early traumatization was assessed using a structured patient interview and the defense styles by means of the questionnaire on defense styles. Reduction in psychological distress and improvement in health-related quality of life formed the parameters against which success of treatment was measured. At the 1-year follow-up, the entire sample showed a distinct improvement. The effect sizes for health-related quality of life ranged from 0.82 to 1.21, and that for psychological distress was 0.81. Patients with early traumatization were significantly more impaired both before treatment and at follow-up; yet they profited from treatment to an extent comparable to patients without early traumatization. The quality of life among patients with highly immature defense styles compared with those with fewer immature defense styles was significantly lower, especially before the start of treatment; however, the former profited from treatment to a significantly higher degree.

Psychodynamisch-interaktionelle Gruppentherapie bei somatoformen Störungen

Ausgehend von einer diagnostischen Klassifikation und Differenzierung somatoformer Storungen und der Beschreibung eines empirisch gestutzten Atiopathogenesekonzepts, beschreibt das Kapitel eine manualisierte psychodynamisch-interaktionelle Gruppentherapie fur Patienten mit somatoformen Storungen. Die einzelnen Phasen der Behandlung werden beschrieben. Das Behandlungskonzept hat sich in der stationaren und in der ambulanten Behandlung bewahrt.

Bedeutung früher Stresserfahrungen und kompensatorischer Schutzfaktoren bei Chronic Fatigue Syndrom (CFS) und Fibromyalgie

Fragestellung: In den letzten Jahren zeigten eine Reihe von Studien eine erhohte Vulnerabilitat fur eine Fibromyalgie (FM) und deren Auspragung als Langzeitfolge fruher Stresseinwirkungen in der Kindheit. Systematische Studien zur Bedeutung fruher Stresserfahrungen fur CFS fehlen bisher ebenso wie ein diesbezuglicher Vergleich zwischen diesen beiden diagnostisch uberlappenden funktionellen Syndromen. Methode: Mit Hilfe eines strukturierten biographischen Interviews (MSBA) wurden bei N=240 Patienten (jeweils n=80 Patienten mit CFS und FM) fruhe Stresserfahrungen und erstmals auch kompensatorische Schutzfaktoren retrospektiv erhoben. Als Vergleichsgruppe diente eine nach Alter und Geschlecht parallelisierte Patientengruppe aus Allgemeinpraxen (VG, n=80). Ergebnisse: 40% der FM-Patienten weisen funf oder mehr fruhe Stressfaktoren auf, wahrend dies in VG nur 17,5% sind. Im Vordergrund steht dabei eine schlechte emotionale Beziehung zu beiden Eltern, korperliche Misshandlung und sexueller Missbrauch sowie psychische Erkrankungen und der Tod eines Elternteils. Wirkten drei und mehr fruhe Stressfaktoren ein, so fuhrte dies zu signifikant haufigeren und langer dauernden Kliniksaufenthalten. Bei CFS-Patienten spielte hingegen eine chronische korperliche Erkrankung eines Elternteils oder auch bei den Betroffenen selbst in der Kindheit signifikant haufiger eine Rolle. Auch die finanzielle Situation war bei FM-Patienten in der Kindheit signifikant haufiger beeintrachtigt; bei CFS-Patienten bestand diesbezuglich kein Unterschied zur Vergleichsgruppe. Je mehr fruhe Stressfaktoren einwirkten, desto weniger standen bei FM wie CFS kompensatorische Schutzfaktoren zur Verfugung. Diskussion: Es handelt sich um die weltweit erste klinische Studie, bei der neben fruhen Stressfaktoren gleichzeitig auch kompensatorische Schutzfaktoren erfasst wurden. Die Arbeit liefert einen wichtigen Beitrag zu einer Differenzierung von pathogenetischen Subgruppen bei diesen beiden Syndromen. Gefordert von der DFG (Eg 125/1), der Innovationsstiftung Rheinland-Pfalz (Hardt & Egle 2000–02) sowie dem BMG (Nix & Egle 1996–99)

Somatoforme Schmerzstörung — Diagnostik, Pathogenese und Therapie

Epidemiologiestudien zur Pravalenz in der Allgemeinbevolkerung fehlten bis vor kurzem. Nach den Ergebnissen der TACOS-Studie (Meyer et al. 2000) liegt die Lebenszeitpravalenz bei 12,3 %! In der Allgemeinpraxis wird von einer Punktpravalenz von 5–10 % ausgegangen, in einer interdisziplinaren Universitatsschmerzambulanz liegt der Anteil bei nichttumorbedingten Schmerzpatienten bei 25–30 % (Nickel et al. 2002).