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Biomedical subjects

M von Rad

Publications and source records attributed to M von Rad.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

[The effectiveness of the initial interview at a psychosomatic- psychotherapeutic outpatient unit].

In a cross sectional study of 1945 consecutive patients seen at a psychosomatic-psychotherapeutic outpatient unit between 1993 and 1995, we investigated how the therapists assessed the effectiveness of their work and what correlations there were with patient characteristics and with the way the therapists conducted the initial session. The therapists' ratings indicated that about two thirds of the patients benefited from the consultation. In the multivariate analysis of the data the most important determinants of effectiveness were found to be the patient's motivation, the ICD diagnosis, the patient's level of personality organisation and the reason for the consultation. In addition, we did a one-year follow-up of 260 patients to analyse the determinants that help patients to agree to the proposed treatment plan. Of the 235 patients for whom treatment was recommended, 174 (74%) actually began a treatment program. Our results show that a patient is more likely to accept the treatment recommendation if the therapist conducts the session in a certain way (e.g. provides detailed information) and helps the patient to find an appropriate therapist.

Adult↗
PubMedDate not supplied

Grief and depression after miscarriage: their separation, antecedents, and course.

Bereavement is a major risk factor for physical illness, grief, depression, and anxiety. In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeutic, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnancy, to make this point. Clinical criteria for differentiating grief and depressive reactions were developed based on phenomenological criteria and theoretical considerations. We hypothesized that the detrimental psychological and physical consequences occur only when the miscarriage was not mourned and resulted in a depressive reaction, but not in a grief reaction. In a controlled, representative study, 125 consecutive women were assessed shortly after their miscarriage (before the 20th week of gestation) and 6 months (N = 94) and 12 months (N = 90) later. Assessments included standardized questionnaires for life events, depression, physical complaints, anxiety, and a specific, multidimensional grief scale (Munich Grief Scale) that we had developed previously. Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-matched community controls. Twenty percent of the patients who had miscarried showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As predicted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depressive reactions were predicted by a history of previous depression, a lack of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.

Abortion, Spontaneous↗
PubMedDate not supplied

Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior?

OBJECTIVE: This study examines factors affecting the frequency of physician consultations by individuals with functional gastrointestinal disorders (FGD) in a group of subjects with functional dyspepsia or irritable bowel syndrome. Systematic selection of persons who were already seeing a physician for one of these problems was avoided by conducting an epidemiological field study rather than a clinical study. METHODS: A representative sample of the German population (N=2201) completed a questionnaire that included, in addition to the criterion (number of physician visits in the past 12 months), items aimed at identifying the target group and questions about physical symptoms, illness behavior, living situation, personality features, and sociodemographic status (a total of 31 predictors). RESULTS: Individuals with functional gastrointestinal disorders who consulted a physician for their gastrointestinal disorders and those who did not differed significantly, especially on psychological measures. The differences between these individuals and the general population were greater for the consulters than for the nonconsulters. Multiple regression analyses yielded nine predictors that explained 40.2% of the variance of the criterion. The best predictors of frequency of physician consultations were the duration of periods with symptoms and psychological factors, such as the severity of depression and the patients' views on the cause of their illness. CONCLUSIONS: The psychopathology seen in people with functional gastrointestinal disorders is of two types: one is a characteristic of the illness itself and the other leads the individual to consult a physician. When gastroenterologists see patients with such disorders, they can assume that they may be dealing with a self-selected group of individuals with psychological stress. Psychological assessment would, therefore, be useful to determine whether a given individual with FGD might benefit from psychotherapy.

Adult↗
PubMedDate not supplied

[Psychological factors of non-ulcer dyspepsia].

Given the absence of any demonstrable organic reason for non-ulcer dyspepsia, and the well known fact, that the psyche influences stomach function, it is widely held, that psychological factors cause NUD. To now, studies are concerned with the psychopathology and personality of NUD-patients, their illness behaviour, and with the relation between stress and abdominal pain. A critical review of these studies revealed, that among the psychological variables mainly anxiety and illness behaviour seems to play a central role in NUD. However, future studies should focus more on the distinction towards other functional disorders and on the differentiation within the heterogeneous group of NUD-patients (especially with regard to physiological variables). Besides this, it seems rewarding to examine the so far scientifically neglected group of subjects with abdominal pain, who do not contact a physician.

Abdominal Pain↗
PubMedDate not supplied

[Therapeutic factors of inpatient psychotherapy--the patients' view].

Inpatient psychotherapy as a complex treatment program coordinates a multitude of specific, possibly therapeutic helpful components. At least in departments of about 20 or more beds the available therapeutic components are composed or dosed in a different kind for certain groups of patients (indication). In the Psychosomatic Clinic with a ward of 22 beds patients with certain psychoneurotic symptoms, bodily dysfunction or psychosomatic illnesses take part in different inpatient psychotherapy programs for 3 months. This very intensive treatment phase is regularly followed by an outpatient psychoanalytic oriented individual or group-psychotherapy for 1 or more years. For the inpatient treatment phase we differentiate 18 possibly therapeutic helpful factors. Preparing systematic studies we asked the patients at the end of their inpatient treatment phase to judge: to what extent the 18 single factors were helpful. Furthermore a personality questionnaire (Giessen-Test) and a checklist of complaints (Giessen Checklist of Complaints) were routinely filled out by the patients pre and post their inpatient time. From this data we derive independent success-scores which enables us to investigate the association between the subjective assessment of the helpfulness of certain therapeutic factors and somewhat independent criterions. The given data of n = 291 patients allow a empirically based discussion of the question: "What relevance do certain components of inpatient psychotherapy alone or together with other components have for certain groups of patients or specific settings?

Adaptation, Psychological↗
PubMedDate not supplied

[Theory and therapy of psychosomatic disorders].

Given the specific problems of the physically sick, the psychoanalytical therapy of psychosomatic patients normally calls for modification of therapy concepts that have proved viable for patients with mental disorders (neuroses) alone. The patients' difficulty in experiencing and expressing the experience of feelings as well as the fixation on one kind of physical complaint render it essential that the patient be unconditionally "accepted" and offered translation aids so that within the patient-doctor relationship the "mute" physical complaints can be assisted towards verbalisation and new emotional experiencing. The special kind of therapy form indicated is determined by the extent of healthy personality elements. Here, in addition to non-verbal procedures, techniques as combined inpatient-outpatient group psychotherapy, the subject of the present follow up study, have proved to be helpful.

Humans↗
PubMedDate not supplied

[Research on results and psychoanalytic therapy. Experiences in the planning and carrying out of a follow up project].

The present project, now entering the initial stages after a 3-year preparation period, covers all patients admitted to the Psychosomatische Universitätsklinik Heidelberg a the beginning of 1978 or later. The project is a prospective one; therapeutic goals are formulated from a psychoanalytic perspective at the commencement of treatment, establishing criteria by which later treatment results can be evaluated as successful or unsuccessful. Furthermore, various criteria have been elaborated to observe changes in the patients during the waiting-period, in treatment and two years after treatment termination. Determining which patients and patients-groups have been successfully treated and which less so provides a basis for the study of the influence of individual factors in the therapeutic process: the various psychoanalytic techniques used, the patient variables and the therapist variables. The project is designed to affect treatment in progress as little as possible, while at the same time using empirical methods to elucidate treatment results and the factors significantly involved in producing such results. The planning aspect and the difficulties encountered in operationalising such a project centred around "Work in progress" are also dealt with.

Follow-Up Studies↗