Wolfgang Milch

Unconventional cancer therapy —survey of patients with gynaecological malignancy

Although the benefits remain unproven, a considerable number of cancer patients use unconventional therapy, in many cases without the knowledge of the oncologist. At the oncological out-patient department of the womens clinic of the Justus-Liebig-University Giessen we conducted a survey of the various unconventional methods used. 38.8% (80/206) of the patients used unconventional therapies, mainly mistletoe extracts (50%), trace minerals (46%), megavitamins (39%), and enzymes (22%). The perceived etiology of cancer determined the choice for the various methods (p=0.00074). Users of unconventional methods suffered significantly more from conventional therapy, had less faith in their doctors, and felt more nervous and emotionally unstable after the diagnosis of “cancer”.

Self-concept, body image, and use of unconventional therapies in patients with gynaecological malignancies in the state of complete remission and recurrence

OBJECTIVE Are there differences in self-concept and body image in patients with cancer recurrence in comparison to patients with complete remission? What impact has cancer recurrence on use, users and non-users of unconventional cancer therapies? PATIENTS AND METHODS One hundred and nine patients with no evidence of disease after gynaecological cancer and sixty-one patients with recurrent disease were analysed for self-concept with the Frankfurter Selbstkonzeptskalen and body image with the Frankfurter Körperkonzeptskalen. Use and motivation for unconventional therapies was assessed with a questionnaire. RESULTS With respect to frequency of use and expected benefits of unconventional therapies no differences were observed between the groups. However, cancer recurrence was found to induce considerable changes of self-concept and body image, some indicating even positive changes due to cancer recurrence. CONCLUSION It may be beneficial to consider body therapy and psychotherapy as a mean to improve body image and self-esteem in cases with cancer recurrence.

Long-term outcomes of short-term and long-term psychosomatic inpatient treatment and their predictors

OBJECTIVES The Clinic for Psychosomatic Medicine and Psychotherapy at the University Giessen, Germany, offers short-term (STT) and long-term inpatient therapy (LTT). METHODS In a prospective, 3-year follow-up study, we examined therapeutic indication, short- and long-term results, outcome predictors, and the utilization of aftercare for both settings. RESULTS STT patients were more frequently acutely ill, suffered from stronger symptomatic manifestations, and were more frequently employed. LTT patients had a greater rate of chronic psychosomatic disorders, personality disorders and somatic comorbidity. In both settings, distress strongly declined during inpatient therapy and remained stable for 3 years. Negative predictors of outcome were infantile object relation patterns and interpersonal problems. We found no differences between STT and LTT patients in terms of the utilization of aftercare. CONCLUSION Duration of psychosomatic inpatient treatment should be differentiated according to the chronicity and nature of the disorder.

Alexithymie bei Neurodermitis

ZusammenfassungHintergrundDie Studie zeigt Zusammenhänge zwischen Neurodermitis und Alexithymie auf und untersucht deren Einfluss auf die hautspezifische Lebensqualität der Betroffenen.Patienten und MethodenEs wurden 62 erwachsene Neurodermitiker mit einer hautgesunden Kontrollgruppe (n=62) verglichen. Erhoben wurden Alexithymie [Toronto Alexithymia Scale- (TAS-)20], hautspezifische Lebensqualität (Dermatology Life Quality Index, DLQI), Erkrankungsdauer und -schwere [Selbsteinschätzungsfragebogen, orientiert am Scoring of Atopic Dermatitis (SCORAD) Index] sowie Erstmanifestation.ErgebnisseDie Prävalenz für Alexithymie (TAS-20≥61) bei Neurodermitikern lag bei 22,6% (Kontrolle 4,9%). Schwierigkeiten bei der Identifizierung von Gefühlen (TAS-20-Subskala) und Schwere der Neurodermitis waren bedeutsame Prädiktoren für die Beeinträchtigung der hautspezifischen Lebensqualität.SchlussfolgerungNeurodermitiker wiesen eine ähnlich hohe Prävalenz für Alexithymie auf, wie sie bei psychosomatisch-psychiatrisch Erkrankten gefunden wurde (Leweke u. Bausch 2009). Aus psychotherapeutischer Perspektive liefert die Studie Argumente für eine Beachtung psychischer Faktoren bei der Behandlung von Neurodermitis. Es wird eine mögliche Indikation für eine spezifische Psychotherapie bei Neurodermitis diskutiert.AbstractBackgroundThe study shows correlations between atopic dermatitis (AD) and alexithymia. Furthermore it examines their influences on skin-related quality of life.Patients and methodsA total of 62 adult AD patients were compared with a control group (n=62) of skin healthy persons. Alexithymia (Toronto Alexithymia Scale-20, TAS-20) and impairment of the skin-related quality of life (Dermatology Life Quality Index, DLQI) were assessed as well as duration, severity [patients’ self-evaluation based on scoring of atopic dermatitis (SCORAD)] and onset of AD.ResultsThe prevalence of alexithymia (TAS-20 ≥61) in AD patients was 22.6% (control group 4.9%). Problems with identifying feelings (TAS-20 scale) and also the severity of AD were significant predictors for the impairment of skin-related quality of life.ConclusionsAtopic dermatitis patients showed a prevalence of alexithymia (22.6%) similar to diseases found in the field of psychosomatic and psychiatric patients (Leweke & Bausch 2009).From a psychotherapeutic point of view the study may provide a further reason for the observance of mental features in AD treatment. A possible indication for a specific psychotherapy in atopic dermatitis is discussed.

Ein Patient mit Golfkriegssyndrom? Zur Diskussion eines unklaren Krankheitsbildes

ZusammenfassungDas Golfkriegssyndrom umfasst neurologische und neuropsychologische Auffälligkeiten bei Veteranen des Persischen Golfkrieges. Die Symptomatik ist vielgestaltig und konnte bislang keinem bekannten Krankheitsbild zugeordnet werden. Als Ursache wird vorrangig eine Exposition mit neurotoxischen Substanzen wie Organophosphaten im Zusammenhang mit den Kriegsereignissen vermutet.Wir berichten über einen 29-jährigen Mann, der unter erheblichen Gedächtnis- und Orientierungsstörungen sowie Doppelbildern litt. Aus der Fremdanamnese gingen zahlreiche Fronteinsätze 1990 und 1991 als Fremdenlegionär im Golfkrieg hervor. Die körperliche Untersuchung ergab eine komplexe Augenmotilitätsstörung sowie einen unerschöpflichen horizontalen Blickrichtungsnystagmus beidseits. Die frühen akustisch evozierten Potenziale enthielten Hinweise für eine Funktionsstörung auf Hirnstammebene, während die kognitiven Störungen eine Entsprechung in den ereigniskorrelierten Potenzialen (P 300) hatten. Die bildgebende Diagnostik blieb ohne nennenswerten pathologischen Befund. Testpsychologische Untersuchungen objektivierten die erheblichen Störungen der Merk- und Erinnerungsfähigkeit, der Lernfähigkeit und des psychomotorischen Tempos. Eine stationäre psychosomatische Langzeitbeobachtung schloss ein dissoziatives Phänomen im Rahmen eines kriegstraumatischen oder konversionsneurotischen Geschehens aus.Unseres Wissens nach handelt es sich bei dieser Kasuistik um die erste Beschreibung eines Golfkriegssyndroms in Deutschland. Der aktuelle Stand der Literatur wird dargestellt.SummaryThe Gulf War syndrome represents neurological and neuropsychological disorders in veterans of the Persian Gulf war. Until today, the various symptoms observed could not be attributed to any defined disease. As a possible cause, exposure to neurotoxic agents such as the organophosphates used during the war has been suggested by many authors. We report on a 29-year-old man who suffered from dysmnesia, disturbance of orientation, cognitive impairment, and double vision. His history revealed several front-line operations in 1990 and 1991 during the Gulf War. Physical examinations showed a complex eye-movement disturbance and a horizontal nystagmus, which was neuro-ophthalmologically confirmed. The early auditory potentials referred to a brainstem dysfunction and the cognitive disturbances correlated to changes in the late-appearing component of event-related potentials (P 300). Brain imaging with CCT, MRI, SPECT, PET, and EEG and CSF showed no pathologies. Neuropsychological tests disclosed severe cognitive impairment especially concerning memory. Three-month follow-up studies in a department of psychosomatic medicine excluded a dissociative disorder as a feature of a post-traumatic stress or a conversion disorder. This is the first case of Gulf War syndrome in Germany. We focus on an unfamiliar complication after the war. The recent literature is reviewed.