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Biomedical subjects

G Schüssler

Publications and source records attributed to G Schüssler.

At least 19 recordsLinked to original sources
PubMed2003

Daily psychosocial stressors and cyclic response patterns in urine cortisol and neopterin in a patient with systemic lupus erythematosus.

This study investigated the complex biochemical responses to personally meaningful everyday stressors in a patient with systemic lupus erythematosus (SLE). For this purpose, a 52 year-old woman with SLE collected her entire urine for 56 days on a 12-h basis for the determination of cortisol as well as neopterin, a cellular immune parameter. Additionally, using questionnaires, daily notes and interviews, extensive psychosocial and psychological time-series data were collected every 12 h. Cross-correlational analyses of the resulting time-series revealed that stressful incidents were associated with cyclic fluctuations in both urine cortisol and urine neopterin. Specifically, whenever the patient anticipated a moderately stressful incident, urine cortisol initially increased 24 h before the incident and then decreased 12 h before the incident. Moderate stressors not anticipated by the patient were associated with an initial increase 24 h following the incident and then with a decrease after a total of 36 h. Moreover, stressors having to do with the patient's extramarital relationship were followed initially by a decrease in urine neopterin after 36 h and then by an increase after a total of 60 h. Our findings indicate that when investigating the relationship between psychosocial stressors and biochemical activity in SLE, appropriate consideration of the data's dynamic nature may be necessary to avoid flawed conclusions.

Activities of Daily Living↗
PubMed2003

Health-related quality of life in patients with coronary artery disease treated for angina: validity and reliability of German translations of two specific questionnaires.

The German versions of two patient-perceived heart disease specific health-related quality of life (HRQL) questionnaires, the Seattle Angina Questionnaire (SAQ) and the MacNew Heart Disease questionnaire, were examined for their psychometric properties in patients with angiographically documented coronary artery disease and angina who were treated either medically or invasively and followed up for 1 year. Both HRQL questionnaires and the modified Canadian Cardiovascular Society (CCS) angina-associated disability scale were completed by 158 patients at baseline and 12 months later when they also completed a generic health status questionnaire, the SF-36. Both specific HRQL questionnaires were acceptable to patients. Three of the four MacNew scales, but none of the SAQ scales, discriminated between patients by baseline CCS disability levels I and IV. Internal consistency ranged from 0.75 to 0.94 for the SAQ and from 0.86 to 0.97 for the MacNew scales. Test-retest reliability over a 4-week period of time ranged from 0.45 to 0.81 for the SAQ scales and 0.61 to 0.68 for the MacNew scales. Over 12 months, HRQL improved (p < 0.001) on three of the five SAQ and on all four of the MacNew scales with the responsiveness statistic ranging from 0.59 to 1.55 for the SAQ and 0.86 to 1.12 for the MacNew. The 12 month scores on all SAQ and MacNew scales were significantly higher in patients who improved than those who deteriorated on the SF-36 reported health transition question. We conclude that the SAQ and the MacNew are both valid, reliable, and responsive in German, that the MacNew discriminates better between angina grades at baseline, that HRQL improves over 12 months with both measures, that the SAQ angina frequency and disease perception scales have the largest effect sizes, and that the 12-month change in HRQL with both instruments was associated with change in SF-36 reported health transition status.

Aged↗
PubMed2003

Quality of life of HIV-infected patients: psychometric properties and validation of the German version of the MQOL-HIV.

OBJECTIVE: To determine the psychometric properties of the recently developed German version of the Multidimensional Quality of Life Questionnaire for HIV/AIDS (MQOL-HIV) and to test its performance in a sample of HIV-infected patients. METHODS: Two-hundred and seven outpatients with HIV/AIDS were interviewed with the German version of the MQOL-HIV; 109 patients were interviewed a second time approximately 2 weeks later. Patients also completed the Beck Depression Inventory (BDI) and the World Health Organization Disability Assessment Schedule II (WHODAS II). RESULTS: The German version of the MQOL-HIV showed satisfactory internal consistency (r: 0.74-0.85, sexual functioning: r = 0.61) and test-retest reliability in most subscales (r: 0.74-0.89, medical care: r = 0.67). Convergent validity with WHO-DAS II and BDI was satisfactory for most domains. Exploratory factor analysis yielded a seven-factor solution with separate factors for physical, emotional, cognitive, social and financial aspects, sexual functioning and medical care. CD4 count and source of infection were associated with most QOL domains, whereas age and gender showed no major impact on QOL. High rates of missing values were seen in the partnership domain and substantial ceiling effects in the area of medical care. CONCLUSIONS: Overall the German version of the MQOL-HIV showed satisfactory reliability and validity. However, the domains of partnership, sexuality and medical care should generally receive more emphasis in future research on QOL assessment in patients with HIV/AIDS and the MQOL-HIV may be improved in these domains.

Adult↗
PubMed2002

[General significance and quality standards in psychosomatic care].

The relevance of psychosomatic and psychotherapeutic in--and--out patient service is evident. Two important examples of psychosomatic care are described: somatoform and cardiovascular disorders. Quality assurance is necessary. There are data concerning the efficacy and the cost-benefit relation.

Austria↗
PubMed2001

[Patients' need for information before surgery].

Frequently, prior to surgery, patients are provided with information in order to meet legal and hospital requirements, but without taking their psychological needs into consideration. In order to learn how to improve this situation, the present study was performed. By means of a semi-structured interview including a newly constructed card system, that avoids giving patients undemanded and possibly harmful implicit information, the need for information of 60 patients before hip- or knee-replacement surgery were investigated in great detail. The results show that 83.3% of the patients want to be prepared by the surgeon, preferably by means of an oral communication (75.0%). Most frequently the day when decision for surgery is made and the day of hospitalization were preferred as point of time for preparation (30% each). Patients were more interested in information about the operation and recovery (43.3% each) than about risks (33.3%). Only 11.7% wanted to get psychological preparation prior to surgery. We conclude that coming into contact and establishing a trustful relationship with the surgeon who does the operation is the most crucial need of surgical patients. He should give presurgical information according to the patient's needs, which often do not focus on the risks, as legal regulations do. By providing psychological preparation for the small number of patients in need, psychological specialists may contribute to improve satisfaction and outcome of surgical patients.

Adult↗
PubMed2001

[The influence of daily psychosocial stressors and associated emotions on the dynamic course of urine cortisol and urine neopterin in systemic lupus erythematosus: Experience taken from two "integrative single-case studies"].

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by flare-ups, the cause of which is unknown. According to new stress concepts, two "integrative single-case studies" have been conducted in order to gather evidence about whether daily stressful incidents and associated emotions interfere with the dynamics of urine cortisol and urine neopterin in SLE. Patients under study collected their urine at home, for a period of at least 50 days, on a daily basis, divided into day and night urine. Additionally, patients filled out questionnaires twice a day to determine their emotional state, life style and disease activity. Each week, patients were examined clinically and interviewed to identify the past week's stressors using the Incidents and Hassles Inventory (IHI, Brown and Harris). Statistical analysis of the serial data was performed using time-series analysis according to Box and Jenkins. In both "integrative single-case studies" we were able to demonstrate that stressful incidents predicted an increase in urine neopterin 36 hours (Case 1) to 60 hours (Case 2) later (p < 0.05). Additionally, in Case 1 the neopterin levels were highly associated with stress resulting from the weekly examinations and interviews. Furthermore, in Case 2 it turned out that depending on their predictability stressful incidents were preceded by a decrease in urine cortisol 12 hours earlier or were followed by a decrease in urine cortisol 36 hours later. And finally, emotional irritation was highly correlated with the course of urine-neopterin. In Case 2 irritation led to an increase in urine neopterin 84 hours later. There were no clinical signs of SLE during both prospective studies. In conclusion, our results validate the idea of "integrative single-case studies" as a new "bio-psycho-social" approach in psychoneuroimmunology. Further studies with SLE patients as well as with healthy probands will be necessary in order to both strengthen and generalize these results.

Adult↗
PubMed2001

[Psychodynamic therapy in chronic pain patients: a systematic review].

Psychoanalysis has made fundamental contributions to our understanding of somatoform pain disorder; however, psychodynamic therapy procedures have not been accorded their due recognition in the treatment of chronic pain. This is due to the inadequate differential indication for the employment of psychodynamic treatment methods, on the one hand, and to the refusal of most of the psychoanalysts to modify the standard psychoanalytic procedures in accordance with the requirements of pain treatment. This article reviews evidence of the modification of psychodynamic therapy procedures and their outcome in chronic pain patients in the context of past research. We conducted a systematic computer-based literature research employing MEDLINE, EVIDENCE BASED MEDICINE, and PSYNDEX data-bases between 1980 and 2000. Psychodynamic therapy procedures are indicated in the first instance for patients with psychic co-morbidity and those with somatoform pain disorder. A modification of the psychotherapeutic technique, involving an approach that is more structured and is also rather supportive at least at the beginning, is necessary. While employing psychodynamic methods in the treatment of pain patients, greater importance should be attached to the physical level and to the 'holding function' of the therapist than is usually the case with the conventional psychoanalytic therapy procedures.

Chronic Disease↗
PubMed2001

[Videotape preparation of patients before hip replacement surgery improves mobility after three months].

Long-term follow-up investigations of the effect of psychological preparation on postoperative physical outcome measures have very rarely been done. In this study a three-month follow-up of a previous investigation of videotape preparation before hip replacement surgery is reported. 100 patients who previously participated in a randomized controlled study received physical examination and x-ray of the hip joint three months after the operation. The mobility of the replaced hip joint was recorded as well as ossifications of the joint. Prepared patients showed a significantly higher improvement of internal rotation, rotational range of motion, and abduction, compared to the controls. The effect sizes ranged between 21% and 32% and, thus, were of clinical relevance. Prepared patients showed less ossifications (15%) that controls (22%), this difference was not significant. For the first time it could be demonstrated that psychological preparation before surgery can not only improve short-term and psychosocial outcome parameters, but also long-term physical measures. The reason for this effect remains to be investigated.

Adaptation, Psychological↗
PubMed2001

[Variability of coping strategies in coronary artery bypass surgery patients].

The state-versus-trait discussion in coping research would become more meaningful if attention is paid to the variability both of coping patterns in individual patients as well as stability of single coping strategies over time. 35 patients undergoing coronary artery bypass surgery were interviewed three times about their coping and stress experience: after cardiac catheterization, on the day before surgery, and six days after surgery. Anxiety and depression were measured. A coping attitude of "positive passivity" was present at all three points of time. While the group means were stable, vast interindividual differences occurred. Also, there was a high degree of scatter in the stability of single coping items; emotion related coping modes were more stable than cognition and action related ones. The variability of the patients' coping patterns correlated positively with the amount of stress experienced and with preoperative depression. Different coping strategies are linked to a different degree with personality traits, emotional coping modes revealing the closest connection. The variability of individual coping efforts might be linked to a personality disposition characterized by a vulnerability for stress and depressive reactions.

Adaptation, Psychological↗
PubMed2001

[The influence of psychosocial factors on the immune system (psychoneuroimmunology) and their role for the incidence and progression of cancer].

Psychoneuroimmunological research investigates the influence of psychosocial factors on the immune systems. We reviewed clinical studies dealing with the following three topics: life events, psychological/psychopathological factors and social support, and their influence on cellular and humoral immune activity. There is strong evidence that stressful life events (especially losses) have a decreasing effect on immunity. Depression has a similar effect and may be the mediator between life events and the immune systems. Results dealing with the influence of social support on immune functions are still inconclusive. In the second part, we reviewed prospective studies concerning the role of psychosocial factors on cancer incidence and progression. Most of the life event studies reviewed have methodological problems, thus the results are heterogenous. There is some evidence that psychological/psychopathological factors can promote cancer progression. This is even more obvious in case of insufficient social support.

Antibody Formation↗
PubMed2001

[Psychosocial medicine--a vision needed in medical education and patient care].

Psychosocial medicine represents the psychosocial aspects in a holistic patient-orientated medicine. It is of great importance in medical education as well as in clinical in- and out-patient treatment. For the near future, further strengthening is necessary in order to prevent the psychosocial aspects from disappearing in medicine. The efficacy and effectiveness of psychosocial therapies need to be further improved.

Austria↗
PubMed2000

[Psychosomatic principles and therapy of chronic diseases].

Chronic illness is the main problem in modern medicine. The manner in which a person psychologically faces his chronic illnesses and attempts to deal with them represents his individual coping process. Psychosocial disturbances are more frequently present in the chronically ill than in the physically healthy and require application of step-wise psychotherapeutic treatment measures. Different problems and disturbances demand distinct therapeutic approaches. The therapeutic measures range from a comprehensive psychosomatic extensive treatment by a physician to professional psychotherapy.

Chronic Disease↗
PubMed1999

The stress-reaction process and the adaptive modification and reorganization of neuronal networks.

On the basis of a comprehensive definition of the stress-reaction process (SRP), the neurobiological and psychological consequences of this process, which are elicited by either controllable or uncontrollable stress, are described. We conclude that controllable stress triggers the stabilization and facilitation of neuronal networks involved in the generation of appropriate patterns of appraisal and coping, whereas uncontrollable stress favors the extinction of inappropriate patterns and the reorganization of neuronal connections underlying certain inappropriate behaviors. Both controllable and uncontrollable stress-reaction processes are therefore inherent challenges to the development and essential prerequisites of the adaptation of an individual's behavior to the demands of the ever-changing external world. The overabundance, as well as the lack, of either kind of SRP may lead to different psychodevelopmental failures and psychiatric disturbances.

Adaptation, Physiological↗
PubMed1999

Determination of clindamycin in human plasma by high-performance liquid chromatography using coupled columns.

A rapid automated method has been developed for the determination of clindamycin, a lincosamide antibiotic, in human plasma. Coupled column HPLC was used after precipitation of plasma proteins with a saturated ammonium sulfate solution. As a first step, the drug and internal standard were trapped on a precolumn of LiChrospher 60RP-select B. A reversed-phase Nucleosil 100 C18 HD column then separated drug and internal standard from each other and from remaining plasma components. The assay was validated in the range 0.2-10.0 micrograms ml-1 plasma. The results obtained for accuracy, intra- and inter-day precision complied very well with the generally accepted criteria for bioanalytical assays.

Anti-Bacterial Agents↗
PubMed1998

Effect of hypochlorite (HOCl)-modified low density lipoproteins and high density lipoproteins on platelet function.

As hypochlorous acid (HOCl) might be a potential candidate for generation of modified (lipo)proteins in vivo , the present study was aimed at investigating the effects of HOCl-modified lipoproteins on platelet function in vitro. Lipoproteins modified with HOCl at concentrations that occur physiologically did not induce spontaneous platelet aggregation. However, low density lipoproteins (LDL; 100 to 500 microg protein/ml) increased platelet aggregation and fluorescence anisotropy in response to ADP (1 and 10 microM) and thrombin (0.1 and 0.5 U/ml) as well as malondialdehyde (MDA) formation as a function of increasing HOCl-concentrations (0.2 to 1.6 mM). HOCl-modified high density lipoprotein subfraction 3 (HDL3) had no effect on platelet function.

Journal Article↗
PubMed1998

Predictors of relapse and rehospitalization in schizophrenia and schizoaffective disorder.

In a German multicenter treatment study, 354 patients with schizophrenia and schizoaffective disorder were followed for 2 years. The data collected were taken as a basis for the present predictor study. For the first time, the technique of classification and regression tree (CART) analysis has been employed for this purpose. CART yielded informative data and appeared to be a useful instrument in predictor research. On the outcome variables "relapse" and "rehospitalization," significant predictor variables were found in several areas: neuroleptic treatment, onset and previous course (precipitating factors, first manifestation, hospitalization in the preceding year, suicide attempts), psychopathology (residual type, schizoaffective disorder), social adjustment (marital status, employment, intensity of life, Phillips score), previous life experiences (traumatic experiences and psychiatric or developmental disturbances in childhood), and biology (gender, age). Our investigation confirmed the generally prevalent views regarding the value of neuroleptic treatment, the multifactorial etiology, and the vulnerability stress model of schizophrenia.

Adult↗
PubMed1998

Thirty-month outcome in patients with anorexia or bulimia nervosa and concomitant obsessive-compulsive disorder.

OBJECTIVE: The present study examines whether concomitant obsessive-compulsive disorder (OCD) indicates a poorer prognosis for patients with anorexia or bulimia nervosa. METHOD: Seventy-five female inpatients who met DSM-IV criteria for anorexia or bulimia nervosa took part in the follow-up study; 29 of these patients met criteria for concomitant OCD. All patients were investigated twice: during inpatient treatment and at follow-up 30 months after discharge. A semistructured diagnostic interview was used as well as the Eating Disorder Inventory and the Hamburg Obsession-Compulsion Inventory--Short Form. RESULTS: At follow-up, 51% (N = 38) of the patients no longer fulfilled DSM-IV criteria for anorexia or bulimia nervosa, but this improvement was not significantly correlated with the earlier presence of concomitant OCD. Analysis of variance for repeated measures revealed significant improvement over time on six of the eight Eating Disorder Inventory subscales for all patients regardless of OCD presence. Furthermore, no significant group effects or group-by-time interactions were identified. Clinically significant change, as reflected by improvement in scores on the Eating Disorder Inventory, was seen somewhat more often in patients without concomitant OCD, but this trend was not statistically significant. The patients whose eating disorders were most improved at follow-up also showed the highest reduction of obsessions and compulsions. CONCLUSIONS: The results suggest that concomitant OCD does not indicate a significantly poorer prognosis for patients with anorexia or bulimia nervosa.

Adult↗