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Biomedical subjects

P Henningsen

Publications and source records attributed to P Henningsen.

At least 19 recordsLinked to original sources
PubMed2006

[Somatoform pain disturbance as the result of trauma].

Orthopedic specialists and emergency surgeons are often confronted with somatoform disorders, which can be the result of traumatization, and they frequently do not recognize this. A combination of pain and several other physical symptoms is typical for somatization, and in these circumstances a psychosocial history should be elicited as a precaution before an elective operation is considered. Recognition of somatization with subsequent referral to more appropriate professional care (e.g., center for multimodal pain therapy, psychosomatic clinic) is crucial. We describe an interesting and instructive case, which it is hoped will help practitioners to recognize such patients and deal with their cases in the correct manner.

Adult↗
PubMed2004

[The Explanatory Model-Interview in the diagnosis of orthopaedic pain patients].

AIM: This study aims to clarify weather the Explanatory Model Interview (EMIC, Weiss, 1997) can detect differences between pain patients with somatoform disorders and pain patients without any psychiatric disorder. We consider the importance of psychological symptom reporting, somatic illness attribution and the subjective experience of exhaustion. METHODS: The (EMIC) and the Structured Clinical Interview for DSM-IV (SKID) were administered to 87 in-patients recruited from the pain therapy ward of the Orthopaedic Clinic in Heidelberg, Germany. The analysis of the EMIC strongly reflects interactional factors and the subjective importance for the patients. RESULTS: Patients with somatoform disorders reported more psychological distress than patients without psychiatric disorder, especially after inquiry. Physical exhaustion was clearly more important in the symptom attribution of somatic pain patients, but an exclusive somatic illness attribution did not appear more often in this group of patients. CONCLUSIONS: Most pain patients with somatoform disorders report psychological distress when they are encouraged. In spite of this emotional strain, most of the pain patients with somatoform disorders attribute their pain complaints to somatic causes. The conspicuous importance of exhaustion in the attribution of patients with somatoform disorders confirms clinical observations and requires further research.

Adult↗
PubMed2004

[The psychosomatics of chronic back pain. Classification, aetiology and therapy].

An overview is given on the current classification, description and treatment of chronic pain with causally relevant psychological factors. It is based on the "practice guidelines on somatoform disorders" and on a thematically related meta-analysis. The classificatory problems, especially of the demarcation of somatoform and other chronic pain, are presented. Additional descriptive dimensions of the relevant psychosocial factors are: pain description, other organically unexplained pain- and non-pain-symptoms, anxiety and depression, disease conviction and illness behaviour, personality and childhood abuse. A modified psychotherapy for (somatoform) chronic pain is outlined. Finally, this aetiologically oriented psychosomatic-psychiatric approach is compared to psychological coping models for chronic pain.

Adaptation, Physiological↗
PubMed2004

[Functional somatic pain syndromes: summary of hypotheses of their overlap and etiology].

Currently it is unclear whether functional somatic syndromes can be explained by one common underlying functional syndrome. In any case it does not seem justified to view functional somatic syndromes as purely psychological disorders (somatized anxiety or depression). Psychiatric comorbidity and life time stress including traumatisations are mainly, but not exclusively responsible for triggering health care utilisation. The lowered pain threshold that can be demonstrated clinically and experimentally in fibromyalgia, irritable bowel syndrome, tension headache and temporomandibular disorders is currently seen primarily as result of an altered central nervous processing of nociceptive input. In addition some results also hint at a disturbance in the hypothalamus-pituitary-adrenal axis. The predominance of female patients can be due to gender specific illness behaviour as well as to estrogen-induced changes in pain sensitivity. In sum, functional somatic syndromes currently are best explained by a biopsychosocial model of predisposing, triggering and maintaining factors. More research is needed particularly to clarify the role of genetic and of cultural factors.

Chronic Disease↗
PubMed2003

Specific phobia is a frequent non-motor feature in stiff man syndrome.

OBJECTIVE: To investigate systematically the rate and type of phobia in stiff man syndrome and its variants, and to compare patients with stiff man syndrome with and without phobia for sociodemographic and neurological characteristics. METHODS: 43 consecutive patients with stiff man syndrome referred to a university department of neurology were assessed using the anxiety disorders interview schedule, revised (ADIS-R), a structured diagnostic interview for anxiety disorders, in addition to a full clinical neurological and psychiatric assessment. RESULTS: 19 patients (44.2%) developed task specific phobia--that is, fear and avoidance of situations difficult to master owing to the motor symptoms of stiff man syndrome (such as crossing streets). Three further patients (7%) had subthreshold phobia--that is, phobic anxiety without avoidance. There were no significant differences between patients with and without phobia in terms of age, illness duration, type of stiff man syndrome, antibody status, or frequency of falls. Patients with phobia were more likely to present with exaggerated startle responses and to have an initial misdiagnosis of psychogenic movement disorder. CONCLUSIONS: Specific phobia is a frequent non-motor symptom of stiff man syndrome. Early recognition is an important aid to correct diagnosis. The aetiology of phobia in stiff man syndrome is unknown. There is no evidence of a direct pathogenic role of autoantibodies directed against glutamic acid decarboxylase in the development of phobia.

Adolescent↗
PubMed2001

["Medical expert assessment in psychosomatic and psychotherapy medicine--social justice questions" guideline].

Guidelines on the medico-legal assessment of patients in the field of psychosomatics and psychotherapy prepared by the "German Society für Psychotherapeutic Medicine" is presented. These guidelines are based on published evidence and on expert consensus among psychotherapists, psychiatrists, judges and social security experts. They give a systematic overview on aspects relevant to the assessment of persons suffering from somatoform disorders, psychological factors in organic diseases and posttraumatic, anxiety, depressive, personality and eating disorders. These aspects are disability, severity, assessment of malingering, of disability and causality.

Disability Evaluation↗
PubMed2000

[Dystonia following peripheral trauma: clinical findings and diagnostic criteria].

Dystonia is a rare neurological complication after peripheral trauma. Incidence and pathophysiology of post-traumatic dystonia are not known. Predisposing factors are sympathetic reflex dystrophia, pre-existing movement disorders or a family history of movement disorders. The main diagnostic goal is to exclude other causes of secondary dystonia. Objective criteria for posttraumatic dystonia are not established, and therefore differentiation from psychogenic dystonia frequently remains difficult. Careful psychiatric examination is obligatory. Clinical criteria are consistency of the symptoms over time and the presence of symptoms compatible with organic dystonia. Polygraphic EMG examinations provide objective correlates of the movement disorder, but exact EMG criteria for the diagnosis of dystonia have yet to be established.

Adult↗
PubMed1996

Psychological factors in the diagnosis and pathogenesis of stiff-man syndrome.

Retrospective psychological evaluation of nine patients with stiff-man syndrome (SMS), seven of whom evidenced autoimmune disease, revealed a characteristic set of psychological symptoms or features: Major stressful life events preceded the development of permanent symptoms by 6 months or less (seven patients); transient motor symptoms occurred in emotionally distressing situations months or even years before the onset of a permanent motor deficit (five patients); after onset, similar situations specifically precipitated or augmented stiffness and spasms (five patients). We also found task-specific fear resembling agoraphobia (six patients) and loss or invalidation of one or both parents, or loss of home, in childhood (seven patients). Eight patients were initially misdiagnosed as having psychogenic movement disorder. We conclude that the common misdiagnosis of SMS as a psychogenic movement disorder is due to the compelling association of a set of salient psychological features, bizarre and fluctuating motor symptoms, and lack of approved neurologic signs.

Adult↗
PubMed1996

[Conversion disorder: psychosomatic aspects instead of psychogenesis?].

The main emphasis of this paper is on a critique of the idea still current in psycho-analysis as well as in psychiatry that conversion can be seen as a purely psychogenic process. This reductionist idea is responsible for some of the difficulties clinicians encounter in their work with patients with a suspected conversion disorder; it may be a consequence of a hysterical structure of this theory. A coherent theory of the psycho-somatic phenomenon of conversion has to proceed in a non-reductionist methodology comprising psychological as well as physiological levels of description and explanation. In this paper, these hypotheses are developed in three dimensions: a) concerning clinical encounters with patients with "pseudoneurological" symptoms; b) looking at the historical development of the Freudian concept of conversion between 1894 and 1916/17, and c) theoretically, including some concepts of cognitive neuroscience.

Adult↗
PubMed1995

Randomized double-blind Scandinavian trial of angiopeptin versus placebo for the prevention of clinical events and restenosis after coronary balloon angioplasty.

Angiopeptin, a somatostatin analogue, inhibits intimal hyperplasia after percutaneous transluminal coronary artery balloon angioplasty (PTCA) in several animal models. This pilot study sought to determine the effect of subcutaneous infusion of angiopeptin on clinical events and restenosis in patients undergoing successful PTCA. One hundred twelve patients were randomized to receive continuous subcutaneous angiopeptin (750 micrograms/day) or placebo infusion from the day before PTCA and for the following 4 days in a double-blind study. An additional subcutaneous injection of 375 micrograms of angiopeptin or saline was given immediately before PTCA. Eighty patients had a successful PTCA, and 75 of these patients with 94 lesions underwent angiography 6 +/- 2 months after PTCA. All 112 patients underwent a 12-month clinical follow-up examination. Age, sex, smoking, diabetes, hypertension, hyperlipidemia, and morphologic features of stenosis were similar in both groups. The hierarchical 12-month event rate (death, myocardial infarction, coronary artery bypass grafting, and repeated PTCA) was reduced from 34% to 25% (p = 0.30) by angiopeptin by intention-to-treat analysis. Restenosis (> or = 50% diameter stenosis) was significantly reduced in lesions treated with angiopeptin (12% vs 40%; p = 0.003). Late lumen loss also was significantly reduced after angiopeptin treatment (0.12 +/- 0.46 mm vs 0.52 +/- 0.64 mm; p = 0.003). In conclusion, continuous subcutaneous angiopeptin infusion for 5 days tended to decrease clinical events and restenosis after PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1995

Effect of blood flow on muscle lactate release studied in perfused rat hindlimb.

The influence of blood flow on muscle lactate and H+ release as well as muscle glyconeogenesis was studied in the perfused rat hindlimb. After 2 min of supramaximal stimulation the perfusate flow rate was 7 (F7), 12 (F12), or 18 (F18) ml/min for 30 min. Perfusate samples were drawn frequently and muscle samples were obtained before stimulation, immediately after stimulation, and at 3, 10, and 30 min of recovery from soleus, white gastrocnemius (WG) and red gastrocnemius. During the first 5 min of recovery lactate release was 35-39% lower (P < 0.05) in F7 than in F12 and F18 but with no differences in total release during recovery. In F7 the concentration of lactate was higher (P < 0.05) in soleus after 10 min (18-20%) and in WG after 30 min (63-67%) than in F12 and F18. During the first 2 min of recovery H+ release was 23-34% lower (P < 0.05) in F7 than in F12 and F18. The difference between H+ and lactate release was larger (P < 0.05) in F7 than in F12 and F18 from 3 to 10 min and from 5 to 10 min of recovery, respectively. Muscle glycogen concentrations after 30 min of recovery were independent of flow in each of the muscles. The present data suggest that 1) in the range of blood flow rates from 0.61 to 0.92 ml.min-1.g-1, lactate and H+ release are independent of the flow rate, whereas at a lower flow rate (0.36 ml.min-1.g-1) release of these substances is decreased; 2) low blood flow influences lactate efflux more than H+ release; and 3) muscle glyconeogenesis from lactate is of minor importance.

Acid-Base Equilibrium↗
PubMed1995

[The course of immunologic parameters in inpatient psychotherapy exemplified by 2 single case studies].

Psycho-neuroimmunology depicts a conceptual frame in which possible interactions between psychic and physical processes can be examined. It could be very significant in the field of psychosomatics when the courses of psychic and somatic processes are examined. However, the research results from this field of study are varied and only for a few parameters of immunity is it possible to prove correlations with psychic variables. Many of the studies that have been conducted up to date were construed as cross-section studies and possibly therefore are not very suitable for depicting the probably very complicated forms of interactions between psychic and somatic levels in an adequate manner. In the framework of stationary psychosomatic psychotherapy two single case studies were carried out in order to examine temporal connections between psychic and immunological course parameters. Both single case studies are to be viewed as explorative attempts of examining questions of examination design and organization which are highly resolved regarding time. Furthermore we report several interesting individual results which emphasize in general the correlation between psychic and somatic parameters also in the course of time. However the limits of such studies regarding the significance of the individual immunological parameters, using time serial analytical methods as well as constructing models in the field of psycho-neuroimmunology are discussed.

Adult↗
PubMed1992

Spinal canal metastases: a late complication of glioblastoma.

The case of a 41 year old woman with a cerebral glioblastoma is reported who developed paraplegia due to a pathologically confirmed spinal metastasis. This and 22 other case histories from the literature suggest that spinal seeding is a rather late complication of cerebral glioblastomas that can be diagnosed on clinical grounds with the help of myelography, CSF cytology and MR imaging.

Adult↗