Thorsten Jakobsen

Somatization revisited: diagnosis and perceived causes of common mental disorders.

The assessment of somatoform disorders is complicated by persistent theoretical and practical questions of classification and assessment. Critical rethinking of professional concepts of somatization suggests the value of complementary assessment of patients’ illness explanatory models of somatoform and other common mental disorders. We undertook this prospective study to assess medically unexplained somatic symptoms and their patient-perceived causes of illness and to show how patients’ explanatory models relate to professional diagnoses of common mental disorders and how they may predict the short-term course of illness. Tertiary care patients (N = 186) with prominent somatoform symptoms were evaluated with the Structured Clinical Interview for DSM-IV, a locally adapted Explanatory Model Interview to elicit patients’ illness experience (priority symptoms) and perceived causes, and clinical self-report questionnaires. The self-report questionnaires were administered at baseline and after 6 months. Diagnostic overlap between somatoform, depressive, and anxiety disorders occurred frequently (79.6%). Patients explained pure somatoform disorders mainly with organic causal attributions; they explained pure depressive and/or anxiety disorders mainly with psychosocial perceived causes, and patients in the diagnostic overlap group typically reported mixed causal attributions. In this last group, among patients with similar levels of symptom severity, organic perceived causes were related to a lower physical health sum score on the MOS Short Form, and psychosocial perceived causes were related to less severe depressive symptoms, assessed with the Hospital Anxiety and Depression Scale at 6 months. Among patients meeting criteria for comorbid somatoform with anxiety and/or depressive disorders, complementary assessment of patient-perceived causes, a key element of illness explanatory models, was related to levels of functional impairment and short-term prognosis. For such patients, causal attributions may be particularly useful to clarify clinically significant features of common mental disorders and thereby contribute to clinical assessment.

Structural change as a predictor of long-term follow-up outcome

Abstract Based on data from psychoanalytic long-term psychotherapies, the predictive value of three measures of pre–post change for retrospective patient assessments of outcome at 1-year and 3-year follow-up was investigated. Pre–post changes were measured using the Global Severity Index (GSI), the Inventory of Interpersonal Problems (IIP) total score, and the Heidelberg Structural Change Scale (HSCS). In line with psychoanalytic theory, it was assumed that structural changes cause especially persistent changes and would, therefore, be most suitable to predict the follow-up criterion. This expectation was confirmed: Pre–post changes in GSI and IIP were only weakly associated with assessments at 1-year follow-up and not at all with assessments at 3-year follow-up. In contrast, correlations between changes in HSCS and outcome assessments were highly significant at both occasions.

Patterns of interpersonal problems and their improvement in depressive and anxious patients treated with psychoanalytic therapy

Interpersonal problems were studied in 121 patients treated with psychoanalytic therapy using the Inventory of Interpersonal Problems. Four characteristic subtypes were identified, which differed in the quality and flexibility of their interpersonal behavior. Independent of the predominant type of interpersonal problems, the psychotherapy treatment led to strong decreases in interpersonal distress and increases in interpersonal differentiation. Psychoanalytic therapy was highly effective for all identified interpersonal subtypes and seems to help patients achieve more satisfactory relationships.

Pain and quality of life following palliative radiotherapy of bone metastases

Hintergrund und Ziel:Strahlentherapie mit palliativer Zielsetzung hat einen positiven Effekt auf Schmerz und Lebensqualität. In den meisten Studien kommt es jedoch durch den Ausschluss sehr kranker Patienten zu einer Positivselektion. Diese prospektive klinische Verlaufsstudie untersuchte die Auswirkungen von palliativer Strahlentherapie auf Schmerz und Lebensqualität bei Patienten mit Knochenmetastasen.Patienten und Methodik:Während eines 2-monatigen Bestrahlungsintervalls wurden 263 Patienten beobachtet. Zur Messung von Schmerz und Lebensqualität wurden die visuelle Analogskala (VAS) sowie der QLQ-C30 der EORTC verwendet. Um eine verzerrende Reduktion der Stichprobe zu vermeiden, wurden fehlende Werte durch die LOCF-Methode („last observation carried forward“) ersetzt.Ergebnisse:Die Bestrahlung führte zu einer Schmerzreduktion. In der Gesamtgruppe kam es zu keiner Erhöhung der Schmerzmedikation. Im Bereich Lebensqualität konnten jedoch keine positiven Veränderungen festgestellt werden. Es zeigten sich deutliche bestrahlungskorrelierte Nebenwirkungen.Schlussfolgerung:Palliative Strahlentherapie reduziert Schmerz bei Patienten mit Knochenmetastasen. Vor- und Nachteile der Behandlung müssen wegen Nebenwirkungen sorgfältig abgewogen werden.Background and Purpose:Palliative irradiation is used to provide pain relief and to increase quality of life. Most studies exclude patients with advanced cancer disease and, therefore, a positive selection results. This prospective clinical study investigates the effect of palliative radiotherapy on pain and quality of life of patients with painful bone metastases.Patients and Methods:263 patients with bone metastases due to advanced cancer were observed with respect to pain and quality of life during a 2-month course of radiotherapy. Missing data were substituted by the LOCF method (last observation carried forward) to prevent a biased reduction of data.Results:Radiotherapy resulted in pain relief. In the complete group, pain medication was not increased. Quality of life was not affected positively. Side effects of radiotherapy increased remarkably.Conclusion:Radiotherapy leads to pain relief. However, risks and benefits must be considered critically due to side effects.

Der Einfluss palliativer Strahlentherapie auf Schmerz und Lebensqualität bei Patienten mit Knochenmetastasen

Hintergrund und Ziel:Strahlentherapie mit palliativer Zielsetzung hat einen positiven Effekt auf Schmerz und Lebensqualität. In den meisten Studien kommt es jedoch durch den Ausschluss sehr kranker Patienten zu einer Positivselektion. Diese prospektive klinische Verlaufsstudie untersuchte die Auswirkungen von palliativer Strahlentherapie auf Schmerz und Lebensqualität bei Patienten mit Knochenmetastasen.Patienten und Methodik:Während eines 2-monatigen Bestrahlungsintervalls wurden 263 Patienten beobachtet. Zur Messung von Schmerz und Lebensqualität wurden die visuelle Analogskala (VAS) sowie der QLQ-C30 der EORTC verwendet. Um eine verzerrende Reduktion der Stichprobe zu vermeiden, wurden fehlende Werte durch die LOCF-Methode („last observation carried forward“) ersetzt.Ergebnisse:Die Bestrahlung führte zu einer Schmerzreduktion. In der Gesamtgruppe kam es zu keiner Erhöhung der Schmerzmedikation. Im Bereich Lebensqualität konnten jedoch keine positiven Veränderungen festgestellt werden. Es zeigten sich deutliche bestrahlungskorrelierte Nebenwirkungen.Schlussfolgerung:Palliative Strahlentherapie reduziert Schmerz bei Patienten mit Knochenmetastasen. Vor- und Nachteile der Behandlung müssen wegen Nebenwirkungen sorgfältig abgewogen werden.Background and Purpose:Palliative irradiation is used to provide pain relief and to increase quality of life. Most studies exclude patients with advanced cancer disease and, therefore, a positive selection results. This prospective clinical study investigates the effect of palliative radiotherapy on pain and quality of life of patients with painful bone metastases.Patients and Methods:263 patients with bone metastases due to advanced cancer were observed with respect to pain and quality of life during a 2-month course of radiotherapy. Missing data were substituted by the LOCF method (last observation carried forward) to prevent a biased reduction of data.Results:Radiotherapy resulted in pain relief. In the complete group, pain medication was not increased. Quality of life was not affected positively. Side effects of radiotherapy increased remarkably.Conclusion:Radiotherapy leads to pain relief. However, risks and benefits must be considered critically due to side effects.

Der Einfluss palliativer Strahlentherapie auf Schmerz und Lebensqualität bei Patienten mit Knochenmetastasen@@@Pain and Quality of Life Following Palliative Radiotherapy of Bone Metastases

Hintergrund und Ziel:Strahlentherapie mit palliativer Zielsetzung hat einen positiven Effekt auf Schmerz und Lebensqualität. In den meisten Studien kommt es jedoch durch den Ausschluss sehr kranker Patienten zu einer Positivselektion. Diese prospektive klinische Verlaufsstudie untersuchte die Auswirkungen von palliativer Strahlentherapie auf Schmerz und Lebensqualität bei Patienten mit Knochenmetastasen.Patienten und Methodik:Während eines 2-monatigen Bestrahlungsintervalls wurden 263 Patienten beobachtet. Zur Messung von Schmerz und Lebensqualität wurden die visuelle Analogskala (VAS) sowie der QLQ-C30 der EORTC verwendet. Um eine verzerrende Reduktion der Stichprobe zu vermeiden, wurden fehlende Werte durch die LOCF-Methode („last observation carried forward“) ersetzt.Ergebnisse:Die Bestrahlung führte zu einer Schmerzreduktion. In der Gesamtgruppe kam es zu keiner Erhöhung der Schmerzmedikation. Im Bereich Lebensqualität konnten jedoch keine positiven Veränderungen festgestellt werden. Es zeigten sich deutliche bestrahlungskorrelierte Nebenwirkungen.Schlussfolgerung:Palliative Strahlentherapie reduziert Schmerz bei Patienten mit Knochenmetastasen. Vor- und Nachteile der Behandlung müssen wegen Nebenwirkungen sorgfältig abgewogen werden.Background and Purpose:Palliative irradiation is used to provide pain relief and to increase quality of life. Most studies exclude patients with advanced cancer disease and, therefore, a positive selection results. This prospective clinical study investigates the effect of palliative radiotherapy on pain and quality of life of patients with painful bone metastases.Patients and Methods:263 patients with bone metastases due to advanced cancer were observed with respect to pain and quality of life during a 2-month course of radiotherapy. Missing data were substituted by the LOCF method (last observation carried forward) to prevent a biased reduction of data.Results:Radiotherapy resulted in pain relief. In the complete group, pain medication was not increased. Quality of life was not affected positively. Side effects of radiotherapy increased remarkably.Conclusion:Radiotherapy leads to pain relief. However, risks and benefits must be considered critically due to side effects.