Biomedical subjects

M Linden

Publications and source records attributed to M Linden.

At least 19 recordsLinked to original sources

PubMed2007

[Workplace related anxiety and phobia].

Work is an important aspect of life. Problems at the workplace must therefore have negative consequences on the mental status and mental problems will interfere with the working place. The relation between anxiety and the workplace is especially important because the workplace causes anxiety due to its very nature. A common final pathway of mental disorders in general, and work related anxieties in particular, are workplace phobias, with panic when approaching or even thinking of the workplace. This is a serious complication with negative consequences for the further course of illness. It makes special therapeutic intervention necessary. This paper describes the phenomenon of workplace related anxieties and phobia and provides a conceptual framework for their understanding.

Anxiety↗

PubMed2006

Minimal emotional dysfunctions (MED) in personality disorders.

The concept of minimal emotional dysfunctions (MED) refers to traditional psychopathology in order to describe, classify, and understand personality disorders. Emotional dysfunctions encompass disorders of affect predominance, production, expression, experience, modulation, and regulation. MED can explain the dimensional nature of personality disorders, their multidimensionality and problems with categorical classifications. It can stimulate research on the etiology of personality disorders in reference to modern developmental brain research and trauma psychology. It can guide new developments in pharmacotherapy and psychotherapy. It is suggested to focus on MED in future developments of the description and classification of personality disorders.

Affective Symptoms↗

PubMed2006

[Pre- and post-treatment in inpatient psychosomatic rehabilitation].

Patients who are referred to psychosomatic inpatient rehabilitation are mostly suffering from long-term illnesses. Therefore, it is necessary to take pre- and post-treatment into account. Epidemiological questions are frequency and type of pre- and post-treatment and their relation to course and outcome of rehabilitation. Pre-treatment, recommendations for follow-up treatment, and course of treatment in 1284 patients of the department of behaviour therapy and psychosomatics of the rehabilitation centre Seehof were assessed. Before admission, 75.4 % of patients had been in psychiatric treatment, and 31.3 % had received psychotherapy. The inpatient stay was significantly longer in patients with psychiatric pre-treatment and those with a combination of psychiatric treatment and psychotherapy. These patients were more often unemployed and showing an insufficient social network. Pre-treatment was unrelated to changes in the SCL-90-R, to physician ratings of therapeutic outcome or the ability to work at the end of rehabilitation. Patients pre-treated by a general practitioner, psychiatrist or psychotherapist returned to that therapeutic setting after rehabilitation. Patients only treated by general practitioners were referred to specialist treatment. These data show the need to integrate inpatient rehabilitation in long-term pre- and post-treatment. One effect of inpatient rehabilitation is to optimize treatment. This requires good communication across different areas of health care.

Adult↗

PubMed2005

[Well-being therapy].

Well-being and quality of life are leading psychological factors that are basically independent of disease and the burdens of life. The more problems a person has to cope with, the more important they become as factors impacting upon an illness. Well-being Therapy (WBT) is a novel psychotherapeutic strategy aimed at promoting psychological well-being. WBT is based on Ryff's multidimensional model of subjective well-being which comprises six subdivisions: mastery of the environment, personal growth, purpose and meaning of life, autonomy, self-acceptance and positive relationships. The aim of this therapy is to improve the patient's performance/activities in all of these areas.

Chronic Disease↗

PubMed2005

[Work disability from mental disorders].

Sick leave certifications allow patients to stay away from work without negative consequences. German regulations state that patients can be granted sick leave when duties can no longer be fulfilled or may endanger health status and when there is a causal relationship between illness and disability. Relevant is not the presence of illness but of a disability which interferes with work requirements. In Germany, an average of 4% of workers are on sick leave at any given time, corresponding to about 2 weeks per year and person. The level of sick leave depends not only on the patient's health status but also on social factors. Mental disorders are a major reason for sick leave. Sick leave can have negative effects by fostering chronicity. In 75% of cases, physicians have been found to grant sick leave incorrectly. It must be kept in mind that not illness per se but only disorders of participation justify sick leave.

Disability Evaluation↗

PubMed2005

[Guidelines and the psychology of medical decision making in the treatment of depressive disorders].

Guidelines aim at improving medical decision making. Guidelines try to influence medical behaviour in contrast to textbooks and reviews which want to improve medical knowledge. Scientific models of medical decision making such as the action theory and empirical data on the effects of guidelines suggest that guidelines will not always reach their goal but instead can even deteriorate medical quality. The problem of guidelines in medicine is discussed in reference to depressive disorders. The problems at stake are nevertheless valid for medicine as a whole. Therefore it must be tested in controlled clinical trials whether guideline exposed physicians have better results with their patients than guideline naive physicians. Only such guidelines should be called evidence based for which positive effects have been empirically demonstrated.

Clinical Trials as Topic↗

PubMed2005

[Residential rehabilitation].

In recent years new avenues of medical rehabilitation have been made possible in order to allow a more flexible and better care for patients. This includes day care and outpatient treatment additional to inpatient services. A further new development are centers which provide "residential rehabilitation". It allows a continuous cooperation with physicians and therapists who send patients or take care of them after discharge. Cooperation with acute care hospitals is easier. Inpatient care, day care and outpatient care can be better integrated. The social network of the patient can easier be taken into account in treatment planning. Patients can be supported when going back to work. Contact with self-help groups can be arranged while the patient is still in treatment.

Ambulatory Care↗

PubMed2005

[The "Mini-ICF-Rating for Mental Disorders (Mini-ICF-P)". A short instrument for the assessment of disabilities in mental disorders].

Supplementary to the description of diseases at symptom level, the International Classification of Functioning, Disability and Health (ICF), edited by the WHO, for the first time enables a systematic description also at the level of disabilities and impairments. The Mini-ICF-Rating for Mental Disorders (Mini-ICF-P) is a short observer rating instrument for the assessment of disabilities, especially with regard to occupational functioning. The Mini-ICF-P was first evaluated empirically in 125 patients of a Department of Behavioural Medicine and Psychosomatics. Parallel-test reliability was r = 0.59. Correlates were found with cognitive and motivational variables and duration of sick leave from work. In summary, the Mini-ICF-P is a quick and practicable instrument.

Disability Evaluation↗

PubMed2005

[Significance of the chronic fatigue syndrome in rehabilitation medicine--status and perspectives].

It appears that from a clinical point of view chronic exhaustion or fatigue is an important factor in rehabilitation. This is, however, first of all a phenomenon that can be described as a function in accordance with the International Classification of Functioning, Disability and Health (JCF), caused by chronic illnesses or chronic excessive stress. The clinical and sociomedical ranking of chronic fatigue or exhaustion in respect of rehabilitation was discussed in the framework of a Workshop at the 12th Rehabilitation Science Colloquium, 2003 from the viewpoints of psychiatric rehabilitation, methodology, sociology and practical rehabilitation, and conclusions for future research were drawn. The definition of chronic fatigue is first of all mainly based on the feeling of chronic tiredness but also on phenomena of disturbed concentration, physical discomfort, headache and disorders of "drive" and mood. A psychiatric diagnosis linked with symptoms of chronic fatigue is neurasthenia, which is arrived at according to precisely defined criteria. Depressive disorder is one of the most important differential diagnoses in this sphere. Examinations by general practitioners revealed that about 90 % of the patients who had been diagnosed as suffering from psychovegetative disorders completely agreed with the diagnosis of neurasthenia. Neurasthenia resulted more often in work disability periods than disorders of somatisation and other psychosomatic diagnoses. Basing on the "IRES" scale "vital exhaustion", singular of even serious changes become evident in about 50 % to 90 % of the patients undergoing rehabilitation, depending on their individual range of indications. As was to be expected, the majority of pathologic findings concerns patients undergoing psychosomatic rehabilitation, since in such cases there is an overlapping with symptoms of psychosomatic diseases. It is, however, remarkable that also in somatically oriented orthopaedic rehabilitation symptoms of fatigue are seen in up to 50 % of the patients. Preliminary studies have shown that these symptoms can be definitely ameliorated within the rehabilitation framework, although pathological signs are still abundantly apparent in follow-up examinations. Markedly severe degrees of "vital exhaustion" and "vocational exhaustion" are also seen in rheumatology patients undergoing somatic rehabilitation. This agrees with case history details related by many female and male patients. Hence, it appears necessary to adapt rehabilitative intervention to both the psychovegetative and the medical behavioural aspects of this symptom. Scientific classification of the entire sphere of chronic fatigue in respect of rehabilitation requires classification of the relevant functions within the ICF framework. To this end it would be necessary to conduct patient inquiries within cross-sectional studies on the one hand and, on the other, a systematic consensus process among experts would have to be used for allocation to the relevant functions. This is the basis for development of suitable assessment tools for use in prospective studies in order to systematically evaluate the impact on functions and especially their effects on activities and participation.

Disability Evaluation↗

PubMed2005

Psychotropic drug presentation in medical and lay press journals.

OBJECTIVE: Media coverage of psychotropic medications affects public views and patients' and therapists' compliance. This study is aimed to identify characteristics of and differences between medical and lay press presentations of psychotropic drugs. METHODS: Two leading German medical and three lay press journals were analyzed in seven annual sets, ranging from 1963 to 1996. RESULTS: There is a clear difference in the reporting on psychotropic drugs between the different types of journals. Lay press journals primarily focus on minor tranquilizers and hypnotics which are indiscriminately presented as one group with other psychotropics, have a rather critical view on these drugs and underrepresent the needs for treatment of major mental illnesses. There were no marked trends over time in the attitude towards psychotropics. On comparing the publications before and after 1984, when benzodiazepines were put under schedule IV by WHO, differences in reports on dependency problems can only be found for the daily newspaper. CONCLUSION: It is the responsibility of psychiatrists to enter the public discussion on how psychiatric disorders should be treated and to run public "awareness programmes".

Anti-Anxiety Agents↗

PubMed2005

Efficacy of cognitive behaviour therapy in generalized anxiety disorders. Results of a controlled clinical trial (Berlin CBT-GAD Study).

BACKGROUND: Generalized anxiety disorders (GAD) are amongst the most prevalent mental disorders. Recent studies have suggested that cognitive behaviour therapy (CBT) is an effective treatment for GAD. A controlled clinical trial was done to evaluate the efficacy of CBT treatment in outpatients with pure GAD who were treated by a therapist working in routine care. METHODS: Seventy-two outpatients, fulfilling GAD criteria according to DSM-IV, were included in the study. From this group, 36 patients (CBT-A) were randomly assigned to 25 sessions of CBT and the other 36 formed a contact control group (CCG). After the contact control period (CC period), these patients were also treated with CBT (CBT-B), allowing not only a parallel group comparison but also an A-B comparison. Therapists were licensed full-time psychologists who worked routinely in outpatient care and had a professional training in CBT. Treatment was done in accordance with a manual, and treatment conformity was controlled by several methods. RESULTS: The reduction in the score on the Hamilton Anxiety Observer Rating Scale was 6.4% (1.5 points) in the CCG, 35.4% (9.5 points) in the CBT-A and 47.3% (10.3 points) in the CBT-B. In the self-rating Spielberger State-Trait Anxiety Inventory, a reduction of 2.7% was seen in CCG, 14.6% in CBT-A, and 11.6% in CBT-B. According to the Clinical Global Impression Rating, 65.6% of patients were still at least moderately ill at the end of the CC period, while this rate was 33.4% at the end of CBT-A, or 15.7% at the end of CBT-B. All these differences between treatment and control group are statistically highly significant. The clinical improvement remained stable over a follow-up period of 8 months. CONCLUSIONS: CBT is an effective method of treatment for GAD. Differences between control and treatment group are comparable to or larger than those reported in studies on antidepressant drugs.

Adult↗

PubMed2004

[Post-traumatic embitterment disorder (PTED). Differentiation of a specific form of adjustment disorders].

Adaptation disorders are a heterogeneous group of mental disorders. Although they play a major role in clinical practice, are difficult to treat, and often lead to chronicity and disability, diagnostic algorithms are vague and scientific research is rare. Clinical practice has shown a subtype of adaptation disorder that is characterized primarily by lasting embitterment after exceptional though normal life events which violate basic beliefs. This disorder can be called post-traumatic embitterment disorder (PTED). A case vignette and results of a pilot study are reported. Critical life events were found to be job loss in 38%, conflicts at work in 24%, death of a loved one in 14%, familial strain in 14%, and other events in 10%. When reminded of the critical event, patients report feelings of embitterment (85.7%), sadness (81.0%), anger (76.2%), or helplessness (75.0%). When standardized assessments are made, they fulfill criteria of various comorbid disorders such as GAD (38.1%), depression (33.3%) and dysthymia (33.3%), agoraphobia (28.6%), or panic (19.0%). Of the patients, 81% said they avoid places which remind them of the critical events. Impairments were suffered in work (70%), leisure (65%), and familial relations (57.1%).

Adjustment Disorders↗

PubMed2004

The relation between suicidal feelings and mental disorders in the elderly: results from the Berlin Aging Study (BASE).

BACKGROUND: The purpose of this study was to demonstrate the influence of several risk factors (particularly physical and mental disorders, loneliness and housing conditions) on the wish to die in the elderly. METHOD: Using data from a population-based sample of 516 senior citizens (70 to 103 years of age) in Berlin (Germany), we compared 54 persons with death wishes with 462 persons without death wishes on several psychosocial risk factors, physical health and psychiatric diagnoses. A logistic regression analysis was also conducted. RESULTS: . The data indicate that the wish to die is strongly associated with the presence of a mental disorder, especially major depression, while higher age, female gender, subjective assessment of physical health and negative living conditions were all only moderately related to death wishes. CONCLUSIONS: Our results emphasize the need for very careful diagnosis of death wishes in the very old and question the view that it is a normal and understandable phenomenon in older age.

Age Factors↗

PubMed2004

Determinants of the quality of life (QoL) in patients with an implantable cardioverter/defibrillator (ICD).

OBJECTIVES: In high-risk cardiac patients the treatment of life-threatening arrhythmias with an implantable cardioverter/defibrillator (ICD) extends survival. Other important outcome criteria are treatment side effects especially the quality of life (QoL). Knowledge of the variables that influence QoL is important for therapy decisions in ICD patients. METHODS: Ninety-three ICD patients evaluated their QoL by the SF-36 after 1-6 years of ICD implantation. The QoL was studied in relation to cardiac function (severity of heart failure, ejection fraction), treatment course (number of shocks), coping styles and psychiatric syndromes. RESULTS: About 30% of the somatic QoL (physical role function, pain) is determined by the patients' somatization tendency, i.e. the extent to which they suffer from non-specific symptoms (sweating, weakness in the legs, nausea). The severity of heart failure had little influence on the physical QoL. The emotional QoL is primarily determined by phobic anxiety of ICD patients. CONCLUSIONS: Psychiatric symptoms are the most important factors to determine the QoL in ICD patients. Behavioural treatment procedures of phobic anxieties and somatization could improve QoL in ICD patients.

Adaptation, Psychological↗

PubMed2003

Mechanisms of mitochondria-neurofilament interactions.

Mitochondria are localized to regions of the cell where ATP consumption is high and are dispersed according to changes in local energy needs. In addition to motion directed by molecular motors, mitochondrial distribution in neuronal cells appears to depend on the docking of mitochondria to microtubules and neurofilaments. We examined interactions between mitochondria and neurofilaments using fluorescence microscopy, dynamic light scattering, atomic force microscopy, and sedimentation assays. Mitochondria-neurofilament interactions depend on mitochondrial membrane potential, as revealed by staining with a membrane potential sensitive dye (JC-1) in the presence of substrates/ADP or uncouplers (valinomycin/carbonyl cyanide p-(trifluoromethoxy)phenylhydrazone) and are affected by the phosphorylation status of neurofilaments and neurofilament sidearms. Antibodies against the neurofilament heavy subunit disrupt binding between mitochondria and neurofilaments, and isolated neurofilament sidearms alone interact with mitochondria, suggesting that they mediate the interactions between the two structures. These data suggest that specific and regulated mitochondrial-neurofilament interactions occur in situ and may contribute to the dynamic distribution of these organelles within the cytoplasm of neurons.

Animals↗

PubMed2003

[Finding the reasons for "workplace phobia". Sick leave can cause damage].

Anxiety engendered by the workplace leads to an inability to work and earn one's living. The term workplace phobia is applied when anxiety leads to avoidance of the workplace. As in the case of school phobia, a range of differential diagnoses may be involved, requiring careful clarification. Such may include post-traumatic stress disease, posttraumatic embitterment, social phobia, personality disorders, depression and organic brain disease. The treatment of workplace-related phobia differs from that of other phobias because of the peculiarities of the workplace. Simply giving the patient sick leave may do more harm than good, and as such needs to be carefully weighed up.

Anxiety Disorders↗

PubMed2003

A comparison of GMS-A/AGECAT, DSM-III-R for dementia and depression, including subthreshold depression (SD)--results from the Berlin Aging Study (BASE).

BACKGROUND: Empirical evaluation of the agreement between different diagnostic approaches is crucial for the understanding of epidemiological results in geriatric psychiatry. OBJECTIVES: In this paper, we analyse differences between widely used diagnostic approaches of dementia and depression and offer evidence that diagnostic thresholds vary substantially on quantitative dimensions, but that conceptual and other differences between approaches must also been taken into account. METHODS: In an epidemiological study of n = 516 persons, aged 70-103 years, we compared psychiatric diagnoses of dementia and depression obtained by GMS-A/HAS-AGECAT, DSM-III-R and clinician's diagnoses of subthreshold depression (SD). RESULTS: For depression, cumulative prevalence of clinician's diagnosis (including SD, GMS-A/HAS-AGECAT and DSM-III-R defined forms) was highest, followed by GMS-A/HAS-AGECAT-diagnosis and DSM-III-R, while for dementia DSM-III-R was followed by GMS-A/HAS-AGECAT. Overall agreement between DSM-III-R and GMS-A/HAS-AGECAT was moderate. Adapting thresholds for AGECAT resulted in slightly better diagnostic efficiency. Diagnostic disagreement was found predominantly for cases with intermediate symptom severity, supporting the hypothesis of differing thresholds between DSM-III-R and GMS-A/HAS-AGECAT, while cases with lower or higher symptom severity were similarly seen as cases or non-cases. CONCLUSION: Disagreement is not only caused by conceptual differences, but also different thresholds of diagnostic algorithms. Adaptation of threshold levels should be feasible, depending on the purpose of the analysis.

Aged↗

PubMed2003

Pathways to care and psychological problems of general practice patients in a "gate keeper" and an "open access" health care system: a comparison of Germany and the Netherlands.

BACKGROUND: The comparison of different health care systems is one way to give empirical evidence to health care reform and policy. The differences between health care systems in which general practitioners serve as gate keepers in comparison to systems in which patients are free to contact every physician and specialist they like are a question of high interest. METHOD: This study compares the Netherlands and Germany, two countries with very similar political, social, and health system structures, but different types of access to the health care system. While Germany offers unconstrained access to specialist ambulatory care, the Netherlands restricts health care utilization by giving primary care a 'gate keeper' function not allowing patients direct access to specialist care. Data from the WHO international collaborative study on psychological problems in general health care (Ustün and Sartorius 1995) were analysed with respect to pathways to care, treatment, and health status. In an initial cross-sectional assessment, in 3-month and 12-month follow-ups, contacts to physicians or hospital admission have also been monitored. RESULTS: There were only marginal differences between the Dutch and the German sample in the sociodemographic characteristics as well as in the diagnostic status with respect to mental disorders. In the Netherlands, 95.5%, and in Germany, 68.8% of the patients presented their 'reason for visit' for the first time to any physician at this index contact with a general practitioner. During the following 3 months, 24% of the Dutch patients, but 60.2% of the German patients, additionally contacted other physicians ( P < 0.001). At 12 months, this rate was 62.9% vs. 78.6% ( P < 0.001). During the 12-month follow-up period, there were 15.7 0/00 hospital admissions in Germany vs. 25.4 0/00 in the Netherlands ( P < 0.005) [corrected]. CONCLUSIONS: Family physicians in a gate keeper system reduce the number of contacts to other physicians and the intensity of treatment, while at the same time the rate of hospital admissions is increased.

Adolescent↗